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P�RMIT �PPLICATIC��V <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.ora <br /> r;PPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 FM �—"/�-O Fj <br /> SITE ADDcR�ESS I l� pqRCEL TAX I.D.# PErZMiT# <br /> � l5� �{ �� V✓l L�5�7�1 nO00��o0'7 Do�u�-c�l <br /> LEGAL LOTNO. BLOCK TRACT � <br /> GESC,r � C�'� <br /> OWNER ADDRESS CINIZIP PHJNE <br /> _< - ��xc-Cc� a ���i— �. 17my, rz,S Lv k����ib'Zs� k�S-33�r-�-��' <br /> TENANT NAME CONTACT FOR PERMIY PHONE <br /> CONTRACTOR ��•.��,�\J�� ��L� ADDRESS CITY2IP PHONE <br /> `t o �3a-N�+s C 5 �`r�7s-g �t{�5-3�.�I-os�' <br /> CONTR.LICENSE# �- ���PL-[j JC�j '� 7 <br /> I LJ •- —c� 3� D i <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> W(} �v�� ✓Electric _Gas_Other <br /> WORK PESCRIPTION r <br /> �LVY����'110Y�-' n-1 jMC�L� ���15`L <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE CR ITEM <br /> Toilel A/C-air handling units <br /> Bathluh Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Shower Waler healer <br /> Kitchen sink&disposal Gas(ireplace <br /> Dishwasher Gas ran�7e <br /> Clolhes washor Clolhes oryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/elc.) Exhaust fan <br /> Backflow prevenler Heat pump <br /> Urinal Unil healer <br /> Drinkin�Founlain Boiler <br /> Floor drain Refrigeralion <br /> Grease trap Woodsto�e <br /> Roof drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify lhal I have read and examined Ihis application and know lhe same to be true and correct. All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whelher;peci(ied herein or not.The granling of a permit does not presum� <br /> to give authority to violate or cancel the provision�f any other slale ur local law regulatin�construction or lho pedormance of <br /> conslruclion.That I am authorized by lhe owrer of ihis property to pedorm the work for c�hich applicalion is made and I comply with the <br /> Stale-CGntractors law 182�CW and 2 . \WAC. <br /> , , �� � — <br /> � , �j -O <br /> SignaWre of Owner ntractodAuthoriz .d genl \ Date <br /> J <br />