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PtRMIT APPLICATI(�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 -ww�:✓.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � ._.b -Oa <br /> SITE ADDRESS , �'ARCEL TAX I.D.# PERMIT# <br /> � � N L. ',�,�,. � I Y.CreO�-�vd <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. — <br /> i <br /> OWNER % ADDRESS CITYIZIP PHONE <br /> --,,��, � c �,q.�i <<.;,��Tr✓r � iD���in �l-L�a�i fc'�,�Iv ��N���i�st/, a��ft. <br /> TENANT NAME AONTACT FOR PERMIT PHONE � Z%� <br /> 1:� :%sO -Przy4,� -'�u�sP��L ��G��') GC �'-Z��U <br /> �E�'if'���;Ii�'�f- sJ�?�c�/' , (y . <br /> �%SHC.JLl.E%L E-MAIL �c.. �.i � - /.-�i-�:t{i: �Gc::Y'�L<< <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE / � <br /> i <br /> CONTR.LICENSE# ����`�/`_�- 'r <br /> USE OF BUILDING I � HEAT SOURCE CONTRACT PRICE OF WORK <br /> �'�" �� � �t` � ���'�` �^ Eleclric Gas Olher . ' =� � � �' <br /> WORK OESCRIPTION <br /> � , , , , � � ��.,.r���'.�✓ l_� � �,- ' '� <br /> ('� ., ;n• ,�.�, . , �.. . .. � � . -��� `� •�. , li.�l �� � . <br /> ' , � - ' ) I`., � C �� '.�• �:.. _�' , q.��. . ti ��. �� 4 i � i.� . . I�wi f ��,i � t.,: . 6� ,. l <br /> ! <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. 7YPE OF FIXTURE OR ITEM <br /> Toilel � � A/C–air h?ndling units <br /> Balhlub I _ Forced a�r syslen„ <br /> Lavalory(wash basin) � Gas piping <br /> Shower � Waterheater � <br /> Kitchen sink 8 disposal 1 _ Gas fireplace <br /> Dishwasher � Gasranc�e <br /> Clothes washer � _ Clothes dryer - I <br /> Waler healer _ Ranc�e hood <br /> � Sink (servicelbar/mop/etc.; ._ Exhausl fan – % <br /> �ack(low preventer _ Heat pump <br /> Urinal Unil healer <br /> Drinkinc� Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease lrap _ Woodslove <br /> Roof drains Olher <br /> Olher r, � � � - � ' � ' <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify lhat I have read and examined this application and know lhe same lo be true and wrrect. All provisions of Izws and <br /> ordinaces gooeming ihis type of work���ill be complied wilh whelher speci(ied herein or noL The granting of a permit does not presume <br /> to give authority to violale or cancel the provision of any other slale or local law regulating construction or the per(ormance o( <br /> conslructicn. Thal I am aulhorized by the owner of lhis property lo perform the work for�.vhich application is made and I comply with lhe <br /> Slatc� CoNractors Law 1�.27 RCW and 2S1ti200 WAC. <br /> • `tl <br /> �, ,� , � �h,� �. _ r-�� <br /> SignaWre o(OwnedContractodAulhorized Agent Date <br /> , <br />