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�\ <br /> - -- - -- PERMIT APPLIC:ATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-6857—www.everettwa.org <br /> APFLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# P RMIT# <br /> 15'_ _ ,��r as S . 02Z�-���IZI�Z l� �`�- �-� <br /> LEGAL LOT NO. BLOC � RACT l7 / <br /> DESC. �O�J LO ' 6:,� <br /> �A�/ /rL�l2 � �Y� oU� ��i � ���,�`i y Zo���� <br /> lq �— ,r_�r <br /> TENANT NAME C NTO.CT POR:eRM1T PHONE <br /> � e� c Jo�qt�1� 1,��, �3�t;�i�'� <br /> CONTRACTOR ��� / I,�� ���.{ ADDRESS r CITY2IP PHONE <br /> ,fal , I/ / /�4� Sov�hc��'�r""'�./ <br /> CONTR.LICENSE# /� � I, d � ,/ � D <br /> /� �� `� <br /> USE OF BUILDING HEAT SOURCE ONTRACT PRICE OF WORK <br /> �2� �Electric �Gas_Other ���� <br /> WORKDESCRIPTION ���� ,�C 7 S�LO{� OF%-(C� ��2 ' <br /> C/ /\ <br /> �l?c L ��s !ar �i�cfv�e �� <br /> e�lf � <br /> PLUMBI MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. 7YPE OF FIXTURE OR ITEM <br /> Toilet A!C–air handling unils <br /> � Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping I <br /> hower Water healer <br /> hen sink&disposal Gas fireplace <br /> � Dis asher '\ Gas range <br /> • Clothe washer Clothes dryer <br /> Laundry ange hood <br /> _ Sink(servic ar/mop/etc.) � E aust fan <br /> Backflow preve er He ump <br /> � Urinal _ Unit h ter <br /> _ Drinking Fountain Boiler <br /> _ Floor drain � Ref�igerati <br /> _ Grease Iwp �, VVoodstove I <br /> �I _ Roof drains � _ Other <br /> � Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined Ihis appliwtion and know ihe same lo be irue and correct. All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whelher specified herein or nol.The grenting of a permit does not presume <br /> to give authority to violale or cancel the provision of any other stale or local law regulating construction or lhe performance of <br /> conslruction. That 1 am authorized by the owner of t ' property lo perform the work�or which application is made and I comply with the <br /> State Co Law 18.2�G 2 96.200 . C. <br /> �� �;. <br /> -' ���=-- - O. � <br /> -ignature o wne NaE or iho � Agent Date �L <br /> �-- — - <br />