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PERMIT AF'PLICATION <br /> CITY QF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � ...�3 ��y <br /> 425-257-£5810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT�r`.;'DS ARE NOT ACCEPTED <br /> SITE ADDRES`f� �4// �/ '� ��CEL T�0 # /6 p P RMIT# � <br /> �� <br /> C_�(c ',3 c.o <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AODRESS CITY2IP PHONE <br /> fY2-drS�-07oU <br /> Sfc+�,L-- Co�pc • �OY,(/ t w /3'�I+ <l.i.+- C...�er! ��cc�r L'4- ?.2�;L�-/797 <br /> TENANT NAME CONTACT FOR P RMIT PHONE <br /> .S�CC�pC047f�-. S (F�l/l ��/p1 yar-y�J-i��S _ <br /> CONTRACTO AODRESS CITYIZ�P PHONE <br /> �1� /)eata.✓ � 37s /3utS Avr �'L <br /> CONTR.LICENSE# S+e aUa i3�/� • w y�s ��y Y��O <br /> Sf�D E',e} ��,,���y,v7 � 'wC 9 9 F oos <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> 2r�� �( _Electric �_Other � /p� Jny��OU <br /> � � <br /> WORK DESCRIPTION <br /> �17-�a�t �.d�r�e,i l��tiw:-,� -��.. !�'��oCiu���J r�ot�e <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. NPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handlirig units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Waler hea;er <br /> Kitchen sink 8 disposal Gas 6raplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray _ Range hood <br /> Sink(serviceibarlmop/etc.) _ Exhaust tan <br /> 3ackFlow preventer Heatpump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CIN OF EVERE7T LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application ar�d know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whciiier specifed herein or not.The r,rant�ng of a c��rmit does not presume <br /> to�ive authoriry to violale or cancel the provision of any other state or local law regulating cn��airuction or the performance of <br /> consiruction.That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> State Contractors Law 1827 RCW and 296200 WAC. <br /> «.� ��� �J <br /> Signature of O ontracror/Authonzed Agent ' 'Date <br /> �L <br />