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; <br /> PERMIT APPLICA�ION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-f3810 — FAX 425-257-8857—www•everettwa.org <br /> APPLICATIONS ARE ACCEPTEU FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.ri PERMIT# <br /> i5�� ���u�ow� 2. Ca5�l-Gal <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> Sn,ra�L� �ovties ISUS 1����oa^c� R-�. EvQ�"F,tt_ lvF�°l`6201 yzs��(���i''�� <br /> TENANT NAME CONTPCT FOR PERMIT PHONE <br /> I ��a.��-J`o��� `1�S� 4�13•233'� <br /> CONTRACTOR - , �'. �.��� •�� ADDRESS CITY2IP PHONE <br /> ,,,.Ic CC1LJ fl' l � ( <br /> .7; i�. (n I��;•�.� <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> t�Q,�1(},Q/YL���� ��14 t'�l� f 0.�tik�L� —Electric � Gas_Other <br /> WORKDESCRIPTION (�n Al� �jG�V'��tNl av,D, ba{..�,tyoawt, �`({��O.XA. ((.'�W���' INC�S �.MU <br /> ic�S�c�l,l '��Lo.��i-�rock • �ZQ�.� �-k�C�lo, lava.ro�•�,o.�nd. tbile� pA waS. <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 1� Toilet _ FVC-air handling unils <br /> I�. BathWb � Y2Se.t 05 WaS _ Forcedairsystems <br /> �� Lavatory(wash basin) _ Gas piping <br /> Shower _ Waler healer <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gasrange <br /> = Clothes washer I _ Clothes dryer <br /> Laundry lray Range hood <br /> Sink(service/bar/mop/etc.) � Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal _ Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain _ Refrigeralion <br /> I Grease trep _ Woodstove <br /> Roof drains _ Olher_ <br /> Olher — <br /> CITY OF EVER[TT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read antl examined this application�nd know lhe same to be true and correct. All provisions of laws and <br /> ordinaces goveming ihis type of work will be complied with whether specifed herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law reyulating wnsiruction or the performance of <br /> construction.That I am authorized by lhe owner of this property lo perform the work for which application is mada and I comply with the <br /> State Contraclors Law 1827 RCW nd 296.200 WAC. <br /> �/fi�i�--��-� �1 l� � �I B' �aS <br /> Si aa e of Owner�lAutl onzed Agent Date <br />