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PEkMIT APPLlCATION <br /> CITY OF EVERETT PERMIT SER�fiCES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-25'7-8810– FAX 425-257-8857–www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FZOIVi 8 AM TO 4 PM /`,v �O�_ � <br /> SITE ADCRESS PAkCEL TAX I.D.# �RMIT# 'h <br /> �j Lunnlonrd Avz C vc�l3 U 7`ll �'0� �'G_ � _.— <br /> LEGAL L07 NO. BLOCK TRACT <br /> DESC. G,'7 �} u _I�I I <br /> OWNER 5o�1rIV�e�.� Cc�1{rctrcrS 4LL ADDRESS CITYIZ;�P PHONE <br /> �u. 3ca ��V3 Eu�-�rt 5H�r3 Yzr��47o - 7z�/ 7 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> Sw.+c�U� CU C.un�fccfcrS LCC 7C�. LGf :k"l3 Evt�ct!- %°�] !3 `/2t• f17a- 7.1'�/ 7 <br /> CONTR.LICENSE ti <br /> 5ou.�clLL 951 I< ct _ <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �1 <br /> � � � _Eleclric X Gas_Other ��� � � Jc� �'GG <br /> WORK DESCRIPTION a<,: �c� C!F 4 n cl,.<I S;�,51c �Ar.. ��� rzs,d encc' - <br /> � � <br /> ,��a��� il��> <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. 1YPE OF FIaTURE OR ITEM <br /> � Toilel A/C–air handling unils <br /> 2 Bathlub � Forced air systems <br /> �L Lavatory(wash basin) �_ Gas piping <br /> �_ Shower � Waler heater <br /> t Kitchen sink&disposal � Gas fireplace <br /> I Dishwasher � Gas range <br /> 1 Clothes washer �_ Clolhes dryer <br /> Laundry tray ( Ran�e hood <br /> _ Sink(service/badmop/etc.) � q-� Exhaust tan <br /> Backflow preventer �_ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> _ Roof drains _ Other� <br /> Olher <br /> — �— — <br /> CITY OP EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify lhat I have read and examined this applicalion and know the same to be lrue and wrrecl. All provisions of laws and <br /> ordinaces goveming lhis type of work will be c.:mplied with whether specified herein or not.The granting o(a permil does not presume <br /> to give authority lo violale or cancel lhe provision o(any olher stale or Iocal law regulating construction or lhe performance of <br /> consiruclion.That I�ulhorized by lhe owner of lhis property to perforci lhe work for which applicalion is made and I comply with the <br /> Stale Contra ot 18.27 RCW and 296.200 WAC. <br /> � i� <br /> // ",�',�f `7-C - 0 5 <br /> Signalure of OwneNContractodAuthorized Agent Date �� <br /> � <br />