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I <br /> PERMIT APpLICATION <br /> CITY OF EVERETT PERMIT SERVICES b y�o ,o � <br /> 3200 CEDAR STREET, EVERETT, WA 98201 I <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.X I PERM���� - ,l` <br /> i � o ".e. evEa, Y �,a�,�.v-1,t 2�0� I Soc� 4oLz�o CS <br /> � �J <br /> LEGAI LOT NO. BLOCK TFACT <br /> �ESC. �- <br /> UWNER ADURESS CITYlZIP PHONE <br /> � r ��,�r�T, Zo�rrt SYv FS�rc�ra s7� '�Z�� /�lrw/��r c/� �'r2��o � <br /> 5TLA17F�S � PHONE <br /> TENANT NAME CONTACT FOR PERMIT <br /> �; ,L � 5 IKciTi � cw�� Z53 - a �' -0� 37 <br /> CUNTRACTOR ADDRESS CITY2IP PHONE <br /> 'l 39 . � <br /> CONTR.LICENSE# �• , ? <br /> USE OF BUILDING `/ HEAT SOURCE ~ CONTRACT PRICE OF WOP.K <br /> , I _Elednc �Gas__Olher I ��j �(�[� <br /> � n. , � .�,t �j � �.i'�1 . <br /> WORKDESCRIPTION �v�u,,,,, _ <br /> s/1�Ke�v,rrcd ��HvP 13�, �,z-��✓i �.� F�x �s�,� 4 y. <br /> - PLUMBING MEGHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> loilet _ NC-airhandlingunils <br /> Eathtub _ Forced air systems <br /> Lavatory(wash basin) _ Gas pipiny <br /> - Water heater <br /> _ Shower Gas fireplace <br /> _ Kitchen sink&disposal — Gas range <br /> _ �ishwasher Clothesdryer <br /> _ Clothes washer Range hood <br /> _ Laundry tray Exhaust fan <br /> _ Sirk(service/bar/mop/elc.) — Heat pump <br /> Backflow preventer Unit heater <br /> _ Urinal goiler <br /> _ Drinking Fountain — Refrigeration <br /> _ Floordrain Woodstove <br /> Grease trap Other <br /> ' Rootdrains — <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> II hereby centify lhat I have read and examined this appliration and know the same l0 6e true and correcl All provisions of laws and <br /> ordinaces goveming Ihis type of work will be complied with whether spedfied herein or nol.The granting of a permit does not presume <br /> to give aulhonty to violate or cancel the prcvision of any other state or Iocai law regulating conslrudion or the peAormance o( <br /> consiruclion.That I am authorized by the owner of this property to perform the work for which application is made and I comply vnth the <br /> State Contr dors Law 18.27 RCW and 6200 WAG. <br /> ���r �' � �vc;/L OS <br /> Signature-o vmedContradYS� � �'d3.gent Date <br /> � <br /> ----- — — ��OC� <br /> ��2 <br />