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P�RMIT APPLICA►TION -� <br /> CITY OF EVERETT PERM17 SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FRO�d B AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# P RMIT# <br /> ZS�, ; �r�Ks�,�,� �-v� �ll " � _ <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> IJ1�Y�ZC�� /'�'L3Y�IJJZ� C�C. ) 2S"a-] .J�21C.�GSJYJ A-JLr �J-IlWT /�ZJ}� <br /> TENANT NAME CONTACT FOR PERi.71T PHONE <br /> /7/1�J y GfJc)JY, E-MAIL y 2.�- I 7I -OJJ^ j <br /> CONTftACTOR AUDR SS CITYIZIP PHONE <br /> ?/7�`'�c_ �� ��'�1 <br /> CONTR.LICENSE il ✓ �'^ ` �n/� ���- <br /> /-Y• <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> G� <br /> _Electric _Gas__C�her `'j�Q O �� <br /> WORK DESCRIPTION �7L ✓��7�s ���.�Z�.2 (,��-vE'-S <br /> .r'—� Nc�v' r.v✓�'i t�L .$t-+�Lv'lGc� <br /> / iv ir�- �` <br /> PLUMBING MECHANICAL I <br /> NO. NPE OF FIRTURE OR ITEM NO. TYPE OF PIXTURE OR ITEM I� <br /> Toilet A!C-afr handlinc� unils <br /> Dalhlub Forced air syslems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Waler healer <br /> Kilchen sink&disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Clolhes v+asher Cblhes dryer <br /> i Waler heater Range hood � <br /> Sink(serviceNarlmop/etc.) _ Exhaust fan <br /> Backflow preventer _ Heal pump <br /> Urinal _ Unit healer <br /> Drinking Foun�ain _ Boiler � <br /> Floor drain Refrigeration <br /> Grease traa _ Woodstove <br /> ' Roof drains _ Other i <br /> Other'v�.41�'t� 8''� 'F'I �" �% -- <br /> W �t�lT'L S�"�2^+] LC <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify lhat I Fave read and examined this application and know the same to be true and correcl AII provisions of laws and <br /> ordinaces goveming Ihis type of work will be complied�vith whelher specified herein or nol lhe yranting of a permil does not presume <br /> lo give authorily lo violate or cancel the provision of any olher stale or local law regulating consVur.tion or lhe performance of <br /> conslruclion.That I am aulhorized by lhe owner of lhis property lo pedorm lhe work for which applicalion is made and I comply wilh the I <br /> S;ate Contractors L� 18.27 RCW and 236.200 WAC. I <br /> I ,-/�i� ��"2�0 - � / I <br /> SignaWreKi(OwnedConiraclorlAulhorized Agent Date —� <br /> �—_ � ----�- -- <br />