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P�RMI�' APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, FVER�TT, WA 98201 /n � � <br /> 425-257-8810-FAX 425-257-8857 -NrNw everettwa.org r J� , � �S '� n <br /> � � <br /> APPLICATIONS ARE ACC[PTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> YG' � 6Ef✓�''-�h /"ln�� w`. PARCELTA:CI.D.# r�a,_�� PFRMIT# <br /> SITEADDRESS � r - � O� � �_�� <br /> f�o,-eft i l.`'1 �S'�305 3. S Uj �5 cb�G z&=�lf <br /> LE6AL LOTNO. I BLOCK TRACT <br /> CESC. S e��� �i�1� �(�� S`�Q.� � <br /> OWNER ADDRESS CITYIZIP PHONE qyf.d�S-��OJC <br /> Si f§.s'� �,� vl��y I I SJ 13��, lvr��"p:� /?,�.r�'�1 C�) `%?C4C <br /> �0.-., l.: 'P � L• }'' , <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> i�-5, a"� � F_���z,�Y,,,{�.:,� �,,� ��,�.. C'��l�;s 3��5 y.�s �i� 3 �Eys <br /> CONTRACTOR �����,� ADDRESS CIN21P PHONE <br /> 51�. D,-� A 3'�S 130'' ,,,ra. � (S�> /r�e%�� /dS� ).fY- Y�'.'n <br /> CONTR.LICENSE# 5,� , }� �OD �✓A J��S�'��S <br /> IUSE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ,;�,%�,'`^N�.�� I —Eleclric =Gas_Other I <br /> � -�n�' wrlh jfc,dr.l'n . LPsI l3�.� .,1� �:. I��o:�h �D�r�-� <br /> WORK DFSCRIPTION G«..��;:� U�,� ���� � <br /> 7'[= .Jn^Y: n:dh .-vc�wG�t � i�P'I0 �IJ � S�� e cJl./� �-, � ....� I4:,.. S '�y <br /> [.._,�^ 1<' ...,i , ' U <br /> l>>i��. <br /> PLUMBING MECHANICAL <br /> NO. 7YPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> A/C-air handling unils � <br /> _ Toilet Forced air systems <br /> _ Bathtub Gas piping <br /> Lavalory(wash basin) — Nlater heater <br /> _ Shower Gas fireplace <br /> _ Kitchen sink&disposal Gas range <br /> _ Dishwasher Clothes dryer <br /> _ Clothes washer F:ange hood <br /> _ Laundry tray Exhaust fan <br /> _ Sink(service/bar/mop/et�.) Heat pump <br /> _ BackFlow preventer Unit heater <br /> _ Urinal Boiler <br /> _ Drinking Fountain Refrigeration <br /> Floor drain Woodstove <br /> Grease trap pther <br /> Roof drains — <br /> Other — — <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> I hereby ceritify that I have read and examined lhis application and know the same to be true and corred. All provisions of laws and <br /> ordinaces governing this type o`work will be complied with whether specifed herein or noi. The granting of a permit does not presume <br /> to give authority to violate or cancel lhe provision of any other state or local law regulating conslruction or the performance of <br /> construction. That I am authorized by lhe owner of this property to perform the work for which application is made and I comply with the <br /> Stale Contractors Law 1827 RCW and 29fi200 WAC. <br /> / .�� ;//Sa <br /> ' /� — J <br /> Signature of.OwneriContractorlAuthorized Agent ate �/� <br /> /� <br /> � <br />