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PERMIT AP�LICATION <br /> CITY OF EVERETT FERMIT SERVICES <br /> 3200 CEDAR STREET, EVEREIT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 -www.averettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �-Z .�/� /� <br /> SITE ADDRESS I PARCEL TAX I.D.# PERMIT# <br /> �DO � 1 , � s �*3oU C- r�✓e 9i`�' ; .2c5()�it1) 0, n 0O � �� ��-63� <br /> LEGAL LOT NO. BLOCK l'RACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> �,��- 5������. � ���,;;,�ei� Po.i(� L�.c <br /> �' �� lrnJ l��l �•-t�•r31. r3�`.o �✓�;�-it ���A v�;r�3 <br /> TENANT NAME CONTPCT FO PERfdIT� FHONE y �S_�i.v. �� �{., <br /> �{�i�jc_ I;'ci�G'i yLi-�S�` .'. l�64^ <br /> L1�Ll.��inc `,t�y � C�i/,.in.i.S�i=. �/i'a..J� �v1C . .J•�SSi CI� n ��"' E•MAIL 5{lu,ah /J(?c�Cqol•C���"� <br /> CON7�RqC�R "—r ADDRESS CITYIZIP PHONE <br /> CONTR.LICENSE p <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> /� � _Electric �Gas_Other � <br /> /Kr�i^�tli�,_t-�,c_S c.�^� 'rnt <br /> ORK DESCRIP i IQN <br /> r/,�n��,sy. �..i �Ce <br /> J <br /> PLUIL�BING MECHANICAL <br /> NO. I TYPE OF FIXTURE OR ITEM IJO. TYPE OF FIXTURE OR ITEM <br /> �_ Toilel ___ A/C-air handling units <br /> Oa1hWb Forced air systems <br /> � Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryer <br /> � Waler heater _ Range hood <br /> I Sink(service/badmop/etc.) _ Exhaust f�n <br /> � DackOow preventer _ Heal pump <br /> � Urinal Unit healer <br /> � i DrinFing Fountain Boiler <br /> I I — Ploor drain � Refrigeretion <br /> Grease�rap Woods�ove <br /> � I __ Roof drains __ O�her_ I <br /> Other <br /> i CIl Y OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I <br /> I hereby certify�hal I have read and examined this applicalion and know tha same lo be�rue and correct. All provisions of laws and <br /> ordinances goveming this type of work will be complied with whether spec�fied herein or noL The oranling of a permit does not presume <br /> ' to give authority lo vwlate or cancel Ihe provision of any olher state or Iocal law regulating r,onstruction or the performance of <br /> construction. That I am authorized by ihe owner of ihis property lo perform the work for which application is made and I comply with the <br /> Slale ConiraclpTg Law 18�2�RCl'J and 296 200 vVAC. <br /> j ; ( � =% �>'j y�/�. �l-/�-/C � <br /> Signature�wnedConiractor/ ut orizedAgen Dale / I <br /> I - � -- - -- - --- -- -- � J <br /> i <br />