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f,�E��MlT A.PPLICATIOi� <br /> ClTY fJF EVEFtET7 PERMIT SERVICr S <br /> 3200 CEDP.R STREET, EVERETT, �V��98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT A�CEP'icD <br /> SITEADDRESS PARCELTAXI.D.:? I P,�12MIT# � <br /> I c�o s� �ur�2�T ��atF[.L �c� 3v � ,��5 ov3 v��� -ov I C�;;��J=9 - _��i <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. �C.L. S1uL}— �T <br /> OWNER AODRESS 1(, CITY2IP PIiONE <br /> Kc i-f-fu� Cole_ !�I o s� Ev�,zUT n-;iw� r��y ar- EtlEl_'G—T w.A- �-�zj , i,oq • o ylZ <br /> TENANT NAME CONTACT FOR PERMIT PI10NE <br /> MLN �/c�l So�PPI �° Cp� ��ZS (a70 �L7DG <br /> CONTRACTOR -i ADDRESS CITY/ZIP PHONE <br /> �Y{-��c.� C�,G Io10 �� [,v�rr�T ��H�Lw� �uC-�G--Ir yz_$-• G�o9- Oy)Z <br /> CONTR.LICENSE# �,(I����}2��L�—I r!r%/_./�l� j "_�, / /',�_ _ <br /> 1� <br /> USE OF BUILDING HEAT SOURrE � CONTRACT PRIr,E OF WORK <br /> Q j�j�G� I _Electric _Gas_Olher T58� �'�� <br /> WORK�ES��vl�LG� l}� o� � l�u.��F `��.,�ri 1'�a N s, IJ G-�w V�tJ vL.s � P�nLIF{L f���'�� N��r✓p u�/��5 � <br /> s i ti'1�S <br /> PLUMBING MEGHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITE�A <br /> Toilet AfC—air handling units <br /> Bathtub Foresd air systems <br /> � Lavatory(wash basin) _ Gas piping <br /> Shower W ater heater <br /> � _1t��. Kilchen sink�-diSp6aaf' _ Gas fireplace <br /> DishwaT Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range nood <br /> Sink(service/badmop/etc.) _ Exhausl fan <br /> BackOow preventer _ Heat pump <br /> Urinal Unit hester <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeiation <br /> Greasetrap _ VJoodstove <br /> Roof drains Other <br /> Other <br /> CIN OF EVERETT LOCAL SALES'iAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined lhis applicafic�i and know the sa�.�e to be lrue and correct. All provisions of lavrs and <br /> ordinaces governing this type of wuk will be compliad with whether spec�fied herein or noL The graniing ot a permit does not presume <br /> to give authoriry to violate or cancel the provision o'any other state or local law reyulating consWctlon or the performance of <br /> construclion.That I am authorized by the owner of this property to perform the worh for which application is made and I comply with the <br /> Stale Contractors Law 18.27 RCW and 296.200 WAC. <br /> � �:� (���� ( /� �1J1L o2ll��i <br /> Signature uf Owner�actor/Authonced Agent Date <br /> � <br />