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NERMIT A�PLICATIc�N <br /> CITY OF EVERETT PERMlT SERVI�ES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> APPLICP.TIONS ARE ACCEPTED FROM 8 AM TO 4 PM �� ��`� `���' II <br /> SITE P.DDRESS PARCEL TAX I.D.# PERMI,�# <br /> ,� i:iQa c,A�N� �-z �� � I��a -oo�7 <br /> LEGAL LOT NO. BLOCK ( /TRACT ORj�UBDIVISION p <br /> � UEsc. � 7q c��� �(!("� �Z 0 (v —O Zl—O ;j ' <br /> OWNER AbDRESS CIN/ZIP PHONE / <br /> �-��lNOL t'ifD7YiC,4� � 2Zl� {-�j}U�Caup( � p,V,?y{(.j 1.Vf� `/2T(ZSJ -,Y"3`!S <br /> TENANT NAME CONTACT FOR PERMIT PHON <br /> ✓e l�er'v�d � 2a���°� r-�zzB . <br /> I / � � • �� � E�M.41L � � yi <br /> CqNTRACTOR ADDRESS CITYIZI° �HONE <br /> ll�rv�al 1��1�N.s LLC. Zz�B /h'bGc�f,,<d � �cu. r-E'l-l- t,�c5 �f�-�3`��- <br /> CONTR.LICENSE7! �ZG J � , � . �A .•��f�7��� / , <br /> �'�-C;//1���1L l i <br /> U5[OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ���� _Eleclric �Gas_Other <br /> WORK DESCRIPTION �� �U <br /> C_�O � ,��'SJ Cr• ���2� <br /> PLUMBING MECHANICAL I <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE UF FIXTURE OR ITEM il <br /> � Toilel a NC- air handiing units I <br /> '� Bathlub � Forced air systems II <br /> �- Lavatory(wash basin) �, Gas piping <br /> T Shower _�_ Water hea�er <br /> Kitchen sink&r+isposal I Gas fireplace <br /> � Dishwashcr I Gas range <br /> J_ Clolhes washer � Clolhes dryer <br /> 1 Waler heater ,� Range hood <br /> _� Sink(service!badmop/etc.) 3 Exhausl tan <br /> � Back(low preventer � Heat pump I <br /> C'� Urinal SZ Unit healcr � <br /> � Drinkin9 Fountain �_ Boiler <br /> j � Floor drain �1 Re(ric�eralion <br /> � I � Grcase trap Q Woodslove <br /> � 4� Roof drains _ Olher <br /> � � _ Other — , <br /> � I — — <br /> CITY-0F flVERETT LOCAL SALES TAX CODE IS 3705 ' <br /> I I hereby ceritify ihal I have read and examined�his a�,plicalion and know the same to be true and correr,t. All provisions of laws and li <br /> ordinaces governing this rype of work will be complied wifh whether speci(ied herein or noL The granting of a permil does nol presume 'i <br /> ito give aulhority to violale or cancei the provision of any other state or bcal law regulating construction or the performance ot '� <br /> , construction. That I am aulhorized by lhe owner of this property lo perform the work for a�hich application is made and I comply wilh lhe j <br /> iState Conlractors Law 18.27 RCW acd 296.200 WAC. � <br /> i z/L .�. <br /> Signalure of O�vner/CoNraclorlAulhurized Agenl / Daley � TO pOSTING l L �t� <br /> � L � <br /> �� - - -- — — -- ---- — <br />