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PERMIT APPLICATION <br /> GTY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVER[Tf, WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www•everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 1 ��� <br /> PARCEL TAX I.D.# PERMIT iF <br /> SITE ADDRESS . _ – <br /> � C� ��� -- .�G, C I�t�c,� ��' <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION fl <br /> OWNER ADDRE55 � CITYIZIP , PHONE l� i�'-� fS� � <br /> , C� �cv� � q , � _ Jct cl�s�n � ��cv�� �t`�' c3 �qz , <br /> ' C <br /> �='��'����l � .I� C?��i't <br /> � <br /> TENANT NAME <br /> I CONTACT FOR PERMIT PHONE <br /> E-MAII <br /> C TYIZIP PHONE <br /> CONTRACTOR �'�4� �(- I L ('�L� �'�LUU� C� ADDRE S','` = 1 j�, �5�, _ <br /> f '. L; .� it ->.''- � � ��Chk �S�%(,�i <br /> CONTR.LICENSE# ;�����•�� ��� CI� ��/�z/�2 1S.s,E <br /> USE OF BUILDING <br /> HEAT SOURCE CONTRACT PRICE OF WORK <br /> Eleclric _Gas_Other <br /> YJORK DESCRIP i ION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FiX.TURE OR ITEM <br /> NO. TYPE OF FIXTURE OR ITEM — <br /> A/C–air handling units <br /> Toilet Forced air syslems <br /> �_ BalhWb Gas piping <br /> Lavatory(wash basin) — Water heater <br /> Shower Gas fireplace <br /> I Kilchen sink&disposal Gas range <br /> Dishwasher Clolhes dryer <br /> Cblhes washer Range hood <br /> I Wa:er hea�er Fxhausl fan <br /> Sink (service/bar/mop/etc.) Heat pump <br /> Backflow prevenler Unil heater <br /> Urinal Boiler <br /> Drinking Fountain Refrigera�ion <br /> Floor drain Woodslove <br /> Grease trap . . � I� Other <br /> Roof drains � � �_y\�.? �" — <br /> _ Other �t_ .,�''2� W � .tv-� — <br /> i.� ,Lv� <br /> CITY OF EVERETT LOCAL SALES TAX CO�E IS 7105 <br /> I hereby certify Ihat I have read and examined this application and kno�v the same lo be true and wrrecL All provisions of laws and <br /> � ordinances goveming ihis lype of wor�will be complied v�ilh whe�hEr specifed herein or not.The gran�ing of a pertnit does not presume <br /> to give authority to violate or cancel the provision of any other slale or local law regulating construction or the performance of <br /> IconsUuc�ion.That I am aulhorized by U�e owner of Ihis property�o perform lhe work for which applicalion is made and I comply with lhe <br /> Slate Contradors Law 1827 RCW and 296200 WAC. ,. _ � v <br /> I ( t <br /> "'� '-� ��'��� � � <br /> � �,,� /�I� � �% I i <br /> SignaWre oi OwnedConlrectodAuthotized Agent <br /> Dale <br /> I <br />