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PE ZIVIfT APPLICATIC _ ] �-" � °5 <br /> CITY OF EVERETT PE�tMiT S�RVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.nrg <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8. CREDIT CARDS ARE NOT ACCEPTED <br /> � SITE ADDRESS PARCEL TAX I.D. # PERMIT# <br /> ! ��z� S�F �r� /�� ��- c% 1.� oS�B ao3 009 v� _�c ��Sc� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> � OWNER AODRESS CITY2IP PHONE <br /> LGC cl�-l213 9��-SS <br /> �+�S � J �r' ( 'Szric 5 �/i 1� 1312 � �aktS/,yp (yY . GiKc STr,r�"1 �/� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> i �G'Ntiy Sv�,.sor• 29�-Y�( 9-� Sq � <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> ,oes�..�yS G�e... sT.rr e...-1� 1SSii ��z7�s?. S� .3t�•co,.,,7� W.. zz6-94Y-Cs'96 <br /> I <br /> � CONTR.LICENSE# <br /> ' d� �4if�/S (�r2)3N `/ <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> S.^ �.s /c F�H,-iy S•�d9/:�.-r d, <br /> �Elec!ric �Gas Olher s" 6 S"'/� o <br /> b�.�Sre'....'T;</ — loS,o�o. <br /> WORK DESCRIPTION <br /> >(�:c�,1,C� /� `� /` <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. NPE OF FIXTURE OR ITEM <br /> Z Toilet A/C-air handling units <br /> / Bathtub Forced air systeins <br /> Lavatory(wash basin) V" Gas piping — rO1 � `�4"6 c� F�p'f Q I3 9 <br /> / Shower � Waterhealer E/c <br /> � Kitchen sink&disposal L Gas fireplace <br /> � Dishv+asher �� Gas range <br /> / Clothes washer ✓ Clothes dryer <br /> Laundry tray ✓ Range hood <br /> Sink(service/badmop/etc.) v Exhaust fan <br /> / Backflow;,reventer Heatpump <br /> Urinal ✓ Unitheater o �'-� �y y a4fc 6oc�� <br /> Drinking Fountain Boiler <br /> Floor drain Re(rigeration <br /> Grease trap Woadstove <br /> L Roo(drains _ Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the sarne io be true and correct. All provisions of laws and <br /> ordinaces goveming this type of work will be complied wilh whether specified herein or not.The granting of a permit does nol presume <br /> ro give authority to violate or cancel the provision of any olner state or local law regulating consWction or the performance of <br /> conslruction. Tnat i am authorized by the owner of this property to perform the work for which application is maCe and I comply with the - <br /> State Contractors Law 18.27 RCVJ and 296.200 WAC. <br /> � .o ' �_ �r�� (.v -�,/ 6� n S � <br /> SirnaWr�ed [ ctor/Authonzed Agent Date i <br /> � <br /> --- - - ��2�' <br /> �r. <br />