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Ptt�rVIIT APPLICATI(�N <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 IO �-a �( `-� � <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> ( j�2 � LvM/3�f,�J C�SS3E3i '7 �•n7ar � ��"l � '� — <br /> LEGAL LOT NO. �LOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYlZIP PHONE <br /> S�'n AND i��H^uDF} D k'H!, 1.S 23 Lc•�t3Nxo �Vt��G77 yz�— ss7E, ' �"�`� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> E-MAIL <br /> CONTRACTOR AODRESS CITY/ZIP PHONE <br /> .7f' M 13cG-��tJ �'�^� T�.,r_ , Y.St9 / 56T"�SP'� SE, [�•Nt.�C �c•E 37� - b''/C.� <br /> CONTR.LICENSE# K`��^ �2. <br /> � Mc3CGf2o� ! Mr' <br /> rUSE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> L X G S t l hn' S� NG L [= !'�NI I L `I <br /> ��:�D��CL _Eleclric _Gas_Other <br /> WORK DESCRIPTION _<�< <br /> (�EntC��E EXisy.�� S (�„¢Q G>�1�`r�tcu.:s w--r� Cr-'�S7ru.�C /V �.e.1 ('�c�r-��_ ��y?.�.... ....-. <br /> ��-� S:�L:s � x . <br /> 22 x C.a� , �l 9,z)3v^9 � <br /> PLUMBING MECHANICAL <br /> ryp, TYPE OF f-IXTURE OR ITEM NO. TYPE OF FIXTURE OR ITCM <br /> Toilel _ A/C-air handling unils <br /> 6alhlub _ Forcedairsyslems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Waler heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clolhes washer _ Clolhes dryer <br /> Waler healer _ Range hood <br /> Sink(service/badmop/etc.) _ Exhaust fan <br /> Back(lov+prevenler _ Healpump <br /> Urinal _ Unit healer <br /> Drinking f=ountain _ Boiler <br /> Floor drain _ Refrigeralion <br /> Grease trap _ Woodstove <br /> Roo(drains _ Olher <br /> other — <br /> CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br /> I hereby ceritify that I have read and examined lhis application and know the same to be lrue and wrrecl. All provisions of laws and <br /> ordinaces goveming this lype of work will be complied with whelher specified herein or nol.The granling of a permil does not presume <br /> ro give auihority to violcde or cancel the provision o(any olher state or local law regulating construclion or lhe pedormance of <br /> conslruction.Thal! am authorized by lhe owner oi this properly to per(orm the work for which applicatiun is made and I comply wilh the <br /> Sla�onlraclors Law 18.27 RC and 256.200 WAC. <br /> . Or� �l%����-�-- � �� �� <br /> $jg�ture of OwnedContraclodAul onzed Ac�enl Date I/� <br /> �_-- — <br /> �— <br />