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� _ <br /> P�RMIT APPLICATIC�N �' <br /> ClTY OF EVEF�E7T PERMIT SERVICES I <br /> 3200 CEDAR STREcT, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-88E7—www.everettwa.org <br /> APPLICATIONS P.RE ACCEPTED FROPJI 8 AM TO 4 PM - De6iT& CREDIT CARDS ARE NOT ACCEPTED � <br /> SITE ADDRESS PARCEL TAX I.D.# P/E�RMIT# <br /> '���� �C7iI,'�'Ji: ��.�C r (,j �7�vi ' � � <br /> LEGAL LOTNO. BLOCK I TRAC7 <br /> DESC. � II <br /> OWN3R ADDRESS CITY/ZIP PHONE �, <br /> ����iY1.y/�.� L �U�L7�NI✓ ��.�f(�"�C`.�� d�c� �i71)+��i�ii� �J�li�� C--U�CL/I <br /> TENANT NAME CONTACT 'OR PERMIT PHONE i <br /> � y� <br /> � /3'��A,J�rE C �L, �EK'A,J C_�JCC� /�c GJ�%✓(yLr'r/✓I� ��vr„�n/�i �L a _ (S�-!L/�I� <br /> CONTRACTOR AD'JRESS CIP.'21P PHONE � <br /> ' ��CONTR.LICENSE# � � �-% G�h�� � � � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Other � <br /> WORK DESCRIPTION <br /> PLUMEING T MECHANICAL <br /> N0. I TYPE OF FIXTURE OR ITEh7 I N0. TYPE OF FIXTURE OR ITEM <br /> ' Toilet A/C-air handling units <br /> Bathb�b _ Forced air systems <br /> � Lavatory (wash basin) Gas piping <br /> Shower W ater heater <br /> S Kifchen sink&disposal Gas fireplace <br /> I _ Dishwasher _ Gas range <br /> I _ Clothes washer = Ciothes dryer <br /> Laundry tray Range hood <br /> � Sink(service/bar/mop/etc.) Exhaust fan <br /> � Backflow preventer _ Heat pump <br /> i � Urinal = Unit heater <br /> Drinkinq Fountain Boiler <br /> � Floo•drain Rerrigeration <br /> �I _ Grease trap _ Wocdstove <br /> I _ Roof drains _ Other <br /> Other <br /> — — — — I <br /> I — — — � <br /> I <br /> � 'l�' CITY OF EVERETf LOCAL SALES TAX CODE IS 3105 <br /> -�� � <br /> ; I hereby ceritify tnat I have read and examined this application and knov+the same to be true and correcL All provisions of laws and <br /> I ordinaces governing this type of work�.vill be complied with�vhether specified herein or not.The granting of a permit does not presume I <br /> to give authonty o violate or cancel the provision of any other state o�local law regulating construction or the pertormance of I <br /> �� construction.:T at I am aulhorized by the owner af this property to periorm the werk tor�vnich application is made and I comply•,vith the <br /> Stale Contr�;.ors Law 18.27 RCW and 296200 VJPC. / <br /> / Li - � <br /> �r i <br /> i3ignatu�e of OwneriCon;r�ctor/Authorized Aoent D ie I <br /> i <br />