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r <br />1-CRMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 —FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. # I P MIT/#�) <br />.S'=J - 505 �. E'Ve,Ytti ,Ai1G1I I �Llli <br />-7 <br />2`7�C� �5 tx�3oLi�c� C/ �/ <br />LEGAL LOT NO. <br />DESG. sEest+EErr).cy-Esi-lcc-T <br />BLOCK <br />TRACT <br />T,-o sEtsH�n- -n-o <br />OWNER Q �L'q gin ADDRESS CITY/ZIP PHONE,J <br />� zz2-51 <br />a�'� IGI S�,? Mat'};I� Street- Fbrl-Ict <br />(-'t�enT�ree F7 taza 00 At_t_(, �{ , oR <br />TENANT NAME CONTACT FOR PERMIT PHONE <br />/-)nu: �Icu,g `umL TnSu►�u�C� �(-7xk 1 F% 11 ivl q 25 -6; c. - G7C`(L) <br />CONTRACTOR ADDRESS C:TY21P PHONE <br />Tnc-, 20-7Cc L-�Y�nnt.Aaal ,�z5-775-q� c� <br />"r 7i 03C0 <br />CONTR. LICENSE 1t cl7U � `� / <br />PAV 155110SPN <br />USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br />I $ <br />M_Electric —Gas _Other G`J r <br />WORK DESCRIPTION 1 � /+ r� <br />ors �-w►`(S i ►'� l,�c�ll ; I.1�u� f� l� SiTcxt�i <br />Y�'l l rIor ol�ii , vt�(,�J <br />,,JJC,,l��n✓v� <br />(� LYNro <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM � <br />-Toilet <br />_ <br />WC -air handling units <br />Bathtub <br />a� sh basin) <br />Forced air systems � <br />Gas piping / <br />=Lavator�-( <br />Shower <br />Kitchen sink 8 disposal <br />Dishwasher � <br />_Gas <br />Water heater <br />fireplace / <br />range <br />_ <br />_Gas <br />Clothes washer <br />_Clothes <br />dryer <br />_ <br />Water heater � <br />Range hood <br />_ <br />Sink (service/barlmop/el <br />Exhaust fan <br />_ <br />BackBow prevenler <br />_Heat <br />pump <br />_ <br />Urinal <br />Unit heater <br />_ <br />_ <br />DrinY.ing Fount <br />Floor drain <br />Boiler <br />Refrige Ion <br />_ <br />Grease t p <br />Woo ove <br />Roof ains <br />Ot r <br />0 r <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3100 <br />I hereby cerilify that I have road and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinates governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any other stale or local law regulating construction or the performance of <br />construction. That I am authorized by the owner of this property to perform the work for which application is made and 1 comply with the <br />Slate Contractors Lev 18.27 RCW and 298.200 WAC. <br />i <br />moo/ �l�z-� (,� .�G.•/7 <br />Signature of Owner/Contr ctodAuthorized Agent ate <br />