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� PERII/IIT A�PLICATION <br /> CITY OF EVERETT PERMIT SFRVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810— �AX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM r --�� - o> <br /> SITE ADDRESS PARCEL TAX I.D.# P RMIT# <br /> a � aco C� i� ��3�� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> �(����' ��SO`l� 1a.(>�1 `�-�-,-� C�,.rf . Cu�e� `�'1�f�11 <br /> TENANTNAME CONTACTFOR ERMIT PHONE <br /> �i-r aSk �h��c e. (:on�2�c�;r�, y�.��l-c�Sh <br /> CONTRACTOR ADDRESS CIN21P PHONE <br /> 1-��tS�- �-hac.2 �.ac��Yc.Flcl�r� �,C . �',� �.b, l�la� Sn�.. tn,'1'-}- <br /> CONTR.LICENSE# <br /> "F�ST CC_ �}�5- 3�7-�50 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRI�OF WORK <br /> C11�2n�- _Eleclric _Gas_Olher <br /> I'\I I� <br /> WORK DESCRIPTION <br /> �� �� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTl1RE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling units <br /> Balhtub Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Shower Water healer <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clol'nes dryer <br /> Waler heater Range hood <br /> Sink(servir,e/bar/mop/elc.) Exhaust fan <br /> Oack(low prevenler Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain Boiler <br /> Floor drain kefrigeration <br /> Grease trap Wocds:ove <br /> Roof drains Olher <br /> Olher _ <br /> CITY OF EVERETT LOCAL SAIES TAX COOE IS 9105 <br /> I hereby ceritify Ihal I have read and examined this application and know lhe same lo be lrue and correcL All provisions of laws and <br /> ordinaces c�overninc�lhis typo of work will be complied wilh whether specified herein or noL The granling of a permit does nol presume <br /> to give authonty lo violale or cancel lhe provision of any olher sta�e or local law re9ulaling conslruclion or the pedo�mance of <br /> conslruclion.Thal I am authorized by lhe owner of lhis property lo pedorm�he work for which appliwtion is made and I comply wilh Ihe <br /> Slale CoNractors Law 18.27 RCW and 296200 WAC. / - <br /> � x� \� I L Z�� ���/ ' <br /> Signature of OwnedContraclodAuthorized Agent Date , � <br />