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F �RMIT APPLICATIvN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-&810 — FiaX 425-?_57-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS � PARCEL TAX I.D.# PERMIT# <br /> � u01 ! Lo�� (��^� � � -ao ,- <br /> LEGAL LOT NO. BLOCK TRACT OR SUBUIVISION# <br /> �ESC. <br /> OWNER HDDRESS CITYlZIP PHONE��.,/_Z��ID( <br /> un <br /> I � I I�l���^ ��, �, �o �� �� s+��,�,, �/� <br /> TENANT NAME CONTACT FOR PERMIT PHONE 3�Q—�7�—�6 Z <br /> C �` 9IIIIAS E-MAIL CQI.y���il.�3915-�� 1 Uin .��� <br /> CONTRACTOR ' ���s � ���-,yv�CJ'D ADDRE S rvIl+ CIT�IIZP PHONE 7 8� <br /> JI I ,� 2 72 �� � �l.�e I�I,J Siahu.�vod (.il4 9879 <br /> CONTR.LICENSE# <br /> o l I � r' �` ��/�,� . <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> xEleclric Gas Other <br /> WORKDESCRIPTION } �j ��D ��� f � �. c�S <br /> t_L <br /> I <br /> i <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI.XTURE OR ITEM <br /> Toilet A/C—air handling units <br /> 6athlub Forced air syslems <br /> Lavalory(wash basin) Gas piping <br /> Shower Water healer <br /> Kilchen sink&disposal _ Gas fireplace <br /> Dishwashzr Gasrange <br /> Clothes washer Cbthes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/elc.) _ Exhaust fan <br /> BackOow prevenler Heal pump <br /> Urinal Unit healer <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease lrap _ Woodslove <br /> Roof drains Olher _ <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I have read and examined lhis application and know lhe same to be lrue and correct. All provisions of laws and <br /> ordinaces c�overning this type o(work will be complied wiih whether specified herein or nol.The granliny of a permil does nol presume <br /> to give authorily to violate or cancel the provision of a:ry olher slale or local law regulating consWction or the performance of <br /> conslruction. Thal I am authorized by the owner o(th:s prop:rty to perform the work for which application is made and I ccmply with the <br /> Sl le CoMIl�rectors Law 1827,f�C and 296.200 WAC. <br /> y1l,�L-vL� �` �l Cr'-� U ��C7� <br /> �i. l �" <br /> Signalure of Owner Conlraclor/Aulhonzed Agent Dale <br />