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P`��MIT APPLICATlG . � <br /> Cll'�Y OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> P;PPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � � a /D <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 1 s �� Lo�,-, v��d A„-c_ M � o oc�-oo� <br /> LEGAL LOT NO. BLOCK TRACT OR SU6JIVISION# <br /> DESC. <br /> OWNER . . AD�RESS CITYIZIP PHONE <br /> A-ti•v� �{a.�l 1SUGo Lc:w�(�arc� �UC �ccrr.r� kl `982U1 42S-ZS� -�tfl0(o <br /> TENANT NAME � CONTACT FOR PERMIT PHONE <br /> E-MAII <br /> CONTRACTOR �G�� �`�k, AODRESS CITYIZIP PHONE <br /> � � qoLS �.I <br /> CONTR. LICENSEk w+eaclo� c-K-�r 3(00• SG�2I- o162 <br /> KR-1,v�. C N'ifOGG> P S� SnU�ntw�Sln �I�250 <br /> USE OF BUILDING � HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Electric ✓Gas_Olher �.3� (`C� � � <br /> WORK DESCRIPTION <br /> � ��e.�l� ilt�7 �US �cNv.c. �'_ 1�.k2 -�c.�� \���� <br /> I <br /> PLUMBING MECHANICAL � <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C -air handling unils � <br /> Balhtub � Forced air systems <br /> Lavatory (wash basin) Gas piping <br /> Shcwer Waler heater � <br /> _ Kitchen sink & disposal _ Gas tireplace I <br /> _ Dishwasher Gas range � <br /> Clolhes washer Clothes dryer � <br /> _ Water heater Range hood I <br /> _ SinY, (service/bar/mop/etc.) Exhaust fan , I <br /> Backliow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> _ Floor drain Refrigeralion i <br /> Grease lrap Woodstove <br /> Roo(drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> I hereby cerlify that I have read and examined this applicalion and know the same to be true and wrrect. All provisions o(laws and <br /> ordinances goveming this type of work will be complied wilh whether specified herein or not. The granting of a permit does not presume <br /> to give authority to violate or cancel ihe provision of any other stale or lo„al law regulating conslruc�ion or ihe performance of <br /> consVuction.That I am aulhorized by the owner ot ihis property to pertorm Ihe work for which application is made and I comply with the <br /> Stale Contraclors Law 1827 RCW and 256200 WAC. <br /> ��. ,�--� `�1� 2� � u I� <br /> � Sig ature of Owner/Contra /Authorized Agent Dale � <br /> I ---- — -- J <br />