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F �RMIT APPLICATII.N <br /> C1TY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 �_,16�OJC <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 ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PER��IT# <br /> v n r �%/.��J'�" <br /> LEGAL LOTNO. BL K TRACT <br /> DESC. <br /> OWNER ADURESS CITY/ZIP PHONE <br /> �t(�,s�s'% �o'i��',Q,niF5 Zo�{ir 5«�i.cfi� Ne� ,�,rT6tA� 9�19�sZo�oa <br /> TENANT NAME �' CONTACT FOR PERMIT � PHONE <br /> ��� P9/� Y�C`'/Ox S� , �j,�c .r1� G�C<, �!/C21T���i -��Z�1 C"7,/!/,3I� <br /> CONiRACTOR r"v�2� �T" ADDRESS � CI1Y21P� HONE `�l� <br /> c // �� 33�c ce��frL �v��71P �' <br /> CONTR.LICENSE#/'��R C��Z�/U� <br /> F ��1i6/D� , <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �L�AiL _EleclricJC Gas_Other /l���� GU <br /> .(� <br /> WORK DESCRIPTION <br /> f�, ji>i G � Co �//2 f��•vc�c L- C/id.Ts� �EJ�/��.T a,�.)� <br /> �yL^ �/iviT �9��,E , �.c�r�,.�rL✓clC GviT/>. ��1�c�; p�,f��;i' �l y� �.2 c L�S <br /> � Ca-� �P-,��� <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE JR ITEM <br /> Toilet A/C-air handling units <br /> Bathtub Forced air systems <br /> _ Lavatory(wash basin) � Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas(ireplace <br /> Dishwasher Gasrange <br /> Clofhes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) � Exhausl fan <br /> Backtlow prevenler Heat pump <br /> Urinal / Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof dreins Other <br /> Olher <br /> I <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I hsve read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied wilh whelher specified herein or not.The granting of a permit does not presume <br /> to give aulhority to violate or cancel lhe provision of any other stale or local law regulating construction or lhe performance of <br /> construclion.Thal I am authorized by the owner of lhis property to pedorm lhe work for which applicalion is made and I comply with the <br /> Slat onlrectors Law 18.27 R and 296.200 WAC. <br /> �iY/�- / ( � 1�.�1/ �/ -�U� <br /> Signat re of Ow�er/Con ctod lhonzed Agent �ate <br /> �2 <br />