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F �RMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 9820 i <br /> 425-257-8810 — FAX 425-257-8857—www.everettwa.org <br /> APPLICATIO�IS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> o2/ ?�j Lu/r�ii�:l�'v^ ���c' ����f[) �_ C�11 <br /> LEGAL LOT NO. BLOCK TRAC'f OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> J'c",�,��/ �`✓�:�:� 2� ZL L�',i�hA�� FGG C(/. ��Jii� j�zc% <br /> TENANTNAME CONTACTFORPERMiT PHONE qZS � 7(.0- ����% <br /> a I� ��� ��'U'�"�� E-MAIL i�. <br /> pw,.0 <br /> CONTRACTOR ADDRESS . CIl"Y21P PHONE I , <br /> /Y!/�L /t'tSiZ,2/{���ni /[l4�{i5 Li/lainlC �J �� r'lc.r,.c�- �:/'i_ � Si�n+t <br /> CONTR.LICENSE# �'�` �L <br /> mcti r:�fty 9Yo ��""'�' <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> � ' ,�Eleclric _Gas Other 2 Z � <br /> l.'s�v��,^ t — <br /> WORKDESCRIPTION . ..�LL. �i�Cit'.l� �"��� ir� � ticoL. �- C�ta� � '`��� <br /> �ti,�>�;� ri�� i��� / I <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTUR[OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Z l'oilet _ A/C–air handling units <br /> Balhtub _ F�rced air systems <br /> Lavatory (wash basin) _ Gas pipiny <br /> / Shower _ Waler healer <br /> i Kitchen sink& disposal _ Gas fireplace <br /> � Di,hwasher _ Gasrange <br /> Clothes washer _ Cloth��s dryer <br /> VValer heater _ P.ange hood <br /> Sink(serviceNadmop/etc.) _ Exhaust fan <br /> Back(low prevenler _ Heat pump <br /> Urinal _ Unil heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease trap _ Woodstove <br /> Roo(drains _ Other <br /> Olher — - <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y lhat I have read and examined this applicalion and know the same lo be true and correci. All provisions o(laws and <br /> ordinaces c�oveming lhis lype of work will be complied wilh whether specified herein o�not The granliny of a permil does not presume <br /> lo give aulhoriry lo violate or cancel lhe provisicn of any other stale or local law regulating construction or the performanr.e of , <br /> conslruction.Thal I am aulhorized by the owner of lhis property to perform lhe work for which application is made and I comply wilh ihe � <br /> Slate Contractors Law 1827 RCW and 296200 WAC. '� <br /> i. � <br /> ,%G�•��-;�� 5 7 D _ <br /> SignaWre of Owrl�/Contraclor/Authonzed Agent Date <br />