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- _ _- - - - --- --- - -------- - --- <br /> P� .�MIT APPL��ATIa, i -� ��� -� 5 � <br /> CITY OF EVERETT PE4MIT SERVICES � <br /> , 32Q0 CEDAR STREET, EVERETT, WA 98201 , �� <br /> , �°� <br /> ; 425-257-8810 - FAX 425-257-8857-wwvd.everettwa.org ' %�L � <br /> I �� , <br /> , APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED I <br /> I SITE ADDRESS PARCEL TAX I.D.# PERMIT# � <br /> i �02� S�F �i /�Hw �!�- � lg oS/8 0�3 oa9 aa � �5c� - ���/j <br /> �' LEGr LOTNO. BLOCK TRACT <br /> � D[SC. <br /> OWtIER ADDRESS CITY2P PHONE � <br /> Zac �.r�-rtit3 9��Sr5 � <br /> t✓al1"c+" �t 3�r �< S Vi/� 13 �2 � la ,�r.s�..�.w rD✓ <br /> . L.�a� S-T<���s [✓ , <br /> ; TENANT NAME I CONTACT FOR PERtAIT PHONE <br /> i I <br /> � �eN.v.. �b/1�.so,., 29L-Y�l9-� 39 6 <br /> � CONTRACTOR ADORESS CITY2IP PHONE '�� <br /> i �oeni,.i��S G�en S?<r ��•-� 13j� � Zr2�,'$'?. S�L .StJ•co.•..�2. Wn 2s6-Ty`t'CJ"J6 ' <br /> ' CONTR.LICENSE# �� <br /> be,�.,ys G��3.v 7 <br /> USE OF BUILDING HEAT SOURCE I CONT ACT PRICE OF WORK ' <br /> ST �v,y �C F<H.-1�� S" Crf�`Cr1' �, <br /> �.�s"r�...�.?i t/ �Eleclric �Gas_Olher S"6 t'�>/< � � <br /> i oS,o 00 <br /> WORK DESCRIPTION <br /> ,C�Jluo-�L�/.��. .�.� �. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilet A,'C-air handling units <br /> / Balhtub Forced air systems <br /> Z Lavalory(wash basin) _� Gas piping - �" - �s"J<l F��P Q 13 C� <br /> % Shower / � Waterhealer £/r f <br /> � Kitchen sink 8 disposal � � Gas fireplace <br /> � Dishwasher ; � Gasran e <br /> _ / Clolhes washer ; ✓ 9 <br /> — Clothes dryer <br /> _ Laundry tray �=. ✓ Range hucd <br /> Sink jservice/6arlmop/etc.) / !% Exhaust fan <br /> _ / Back(low preventer Heat um � <br /> _ Urin21 � Uni(Y eate o -v-.� �.y y Q a,ce 6 od�� <br /> _ Drinking Fountain '— Boiler � <br /> Fleor drain Refrigeration <br /> Grease trap Woodslove <br /> � Roof drains Other <br /> Other — <br /> _I <br /> CIN OF EVERETT LOCAL SALES TAX COOE IS J105 <br /> I hereby ceritify lhat I have read and examined lhis application and know the same to be true and wrrect. All provisions of laws and <br /> ordinaces governing this type of work will be complied wilh whether specified herein or not.The granting of a permit does not presume <br /> e� give authonry to violate or cancel ihe provision of any olher state or local law regulating consWction or the performance of <br /> ;:onstruction.That I am authorized by the owner o(this property lo perform lhe work for which application is made and I comply wilh the - <br /> 4ate Contractors Law 78.27 RCW and 296.200 WAC. � <br /> ��,� �.. �,.--o— �P -�,/ 6��Fa-� <br /> Signature o Owned t�dctodAuthonzed A ent Date � � <br /> . . .. _ .. _ __ . _. -_ ---- -- ---. _._ ___ - - -- _. ��I <br /> _.-.-- —_ -- --�' <br /> : <br />