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PERMI� APPLI�A1'10(V <br /> CITY OF EVERETT PERMIT SERVI�ES <br /> 3200 CEDAR STREET, EVERETT, WA 98207 �� d —D � <br /> 425-257-8810—FAX 425-257-8857—www.everetD�va.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM I %'� ��J / " � / <br /> SITE A6DRESS ��,'�J:/.� I PARCEL TAX I.D.# �PJERMIT# <br /> iC' ��1.�-7 � l( illl i�^ , ` �'�•/�i:� f� ��1� r ) I L. / �7� �0 <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. I� � t�,a n�l,o�n-I-erc i�l <br /> OWNER ADDRESS � CIN/ZIP PHONE �;d��•7�.�./ <br /> �i�� ���ncJ�a P��il��,c�n ���� i�--'t4 r»c�.Srnl,c�,��sl� , �� 98asD <br /> TENANT�AME CONTACTFORPERMIT PHONE <br /> �{iCK g,�riFsnn LC'�� �'Z`i'J-10'2��'�G �'IOM2 <br /> �{�Gw(1r� Sa�du (��riFs��n cPu �-zs� ;��r �3�c� �-c�.�� -r�yi <br /> CONTRACTOR ADORESS CITY/ZIP PHONE <br /> b�Jn�er" ���bcO��trc�C{�r <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> 5���-- Eleclric '�as Other <br /> WORK DESCRIPTION <br /> "� '3 s���uu� `��'�� l� � �-- <br /> ��i <br /> � _. <br /> PLUMt31NG MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilet 1 A/C-airhandlingunits <br /> Bathtub 1� 2. � v Forced air systems <br /> �� Lavalory(wash basin) �I � � � Gas piping <br /> �_ Shower P - / i� Waler heater <br /> � Kilchen sink&disposzl � � Gas fireplace t <br /> � Dishwasher / Gas range <br /> 1_ Clolhes washer / Clothes dryer <br /> � Vvaler heater I�� Range hood <br /> _ Sink(service/bar/mop/etc.) Exhausl fan>>� i I I i �-�; � <br /> Backflow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinkin�Founlain Boiler <br /> Floor drain Refrigeralion <br /> Grease trap Woodstove <br /> Roof drai�s Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y lhat I have read and cxamined ihis application and know ihe same lo be true and correcl All provisions of laws and <br /> ordinaces goveming Ihis type oF work will 6e complied�vith whelher speci(ied herein or noL The granling ot a permit does nol presume <br /> lo give aulhority lo violate or cancel ihe provision of any other slale or local law regulating conslruction or lhe pertormance of <br /> cor.slruction.Thal I am aulhorized by the owner of this pmperty to pedorm lhe work for which application is made and 1 comp�wilh the <br /> Stale Contractors Law 18.27 RCW and 296200 WAC. � �� i <br /> C�:� /7 . -� ( J'��1 i'' , <br /> ,J�,._,l -r-�-. �-�U -CJ/ i '/ <br /> SignaWre of OwnedContractodAuthorized Agent Date _ <br /> 11 f ,)%'� ��� <br />