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! _ <br /> P�RMIT APPL�GATIO�V <br /> CITY OF EVERETT PERIIRlT SER`✓ICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 – FAX 425-257-8857 –www.everettwa.org <br /> APPLICATIONS ARF ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CRE017 CAROS ARE NOT ACCEPTED <br /> SITE AL`�RESS ���;�; 5� � �v: v-`�� PAP.CEL TAX I.D.# �RMIT�# � <br /> M!.�C� lr.J.A/ �51:.. '-�--�..' �C�7CJ_ '� �_S'`�? '.'',CJ4.�.�r.�_� '�LJ. <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ,-��/g �,<<�, i ,n,�.r��� ,-�c�-�c� ADDRESS CITYIZ�IP� \ PHONE <br /> 'i��1<� Str C�'l��T1� �r✓'..��LL� V-'�' ��ZS C-�U`i U�j.a> <br /> �.. "-1 C�L.�\�•��.�� C_L.C.� r../�cL. W j', `��1 rr l l>? <br /> `�Y�?c�`�'.3 <br /> TENANT NAME CONTACT FOR PERMIT . PHONE <br /> ir.�<Tr-�-�_ �2JJi�i.7 :���'-�VIc_ � � .� GIV� GT � ��-U'--�' C � n <br /> i l��f_YZa: -_-.'l-+ IU� C1..Y (2_� 1' � C>�J.] / <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> I�f (ZI�C,��c:b�E- r'l`:Sot . i�s-. {ot0 S�r�r'✓�`(LL''.-1 �'l/c�R� �/'� <br /> CONTR.LICENSE# M`. L,L W�- � TC,r 1 U= c^ �,J '�`-f� uC}� ":�<j-� <br /> KI (Li Lc'_fl ' %- ��' r . �' -' 1;37��� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> :.J t� - � �/ _Elec�ric �t Gas _Other It�C��,U � `-�� <br /> F�� 'y, <br /> WORK DESCRIPTION <br /> /-.i_,C> �c:r" l�_.;,_ � l , I �cz�f� , �'1-1r����� �t',:J���l1_I�, �� `_��_Z�� �'- I�1 tti �,':.f� <br /> PLUMBING / ,• MECHANICAL `� <br /> NO. TYPE OF FIX7URE OR ITEM Y��"� NO. TYPE OF FIXTURE OR ITEM , <br /> Toilet A/C-air handling units <br /> Balhtub Forced air syslems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water healer <br /> Kilchen sink 8 disposal Gas freplace <br /> Dishwasher Gasrange <br /> Clothes washer Clottes dryer <br /> Laundry lray Range hood <br /> Sink(service/bar/mop/elc.) Exhaust fan <br /> Backflcw preventer Heal pump <br /> Urinal Unit healer <br /> Drinking Fountain _ Boiler <br /> Fleor drain Refrigeralion <br /> Grease trep Woodslove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX C06E IS 3105 <br /> I hereby ceritify that I have read and examined ttis applica:ion and know:he same to be lrue and correct. All provisions uf laws and <br /> ordinaces governing this lype of work will be conplied with whether specified herein or not.The granting of a permil does not�resume <br /> to give authoriry to violate or cancel the provision of any other stale or local law regulating consWction or the performance of <br /> construction.That�am authorized by lha owner of this property lo pedorm the work(or which application is made and I comply with the <br /> State Contraclors Law 18.27 RCW and 296.200 WAC. <br /> l -- � <br /> _ 7 � <br /> i�. .� ' _ � '/ �/�. ._�) �'_i�� � �r'�`�— <br /> SignaWre�of OwnedContraclor/Authorized Agenl ' Date I/a <br />