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� FtaMl`T APPL�CAT�uN <br /> CITY OF EVERETT PERMIT SERVICtS <br /> 3200 CEDAR STREET, EVERETT, V'A 98201 <br /> 425-25'7-8810 - FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �p �� -D� <br /> SITE ADDRESS PARCEL TAX I.D.# I PERI� T# <br /> � � .LS! K E:,t3� L � � oa o��0 00 7�_1 C, �o `"! -�r U <br /> LEGAL LOT N� -B THP�E=FOR-SU881V76i9K�1- <br /> DESC. � �-� ��� l�oa - D��� - 0� c� <br /> OYlNER ADDRESS CITY/ZIP PHONE j,s- ., ` <br /> �=��PL J�'n�. c� z.zi���- �LA�O v�� ,�v,��-"W� . za� <br /> TENANT NAME CONTAC7'FOR PERMIT PHONE Z( �j� �� <br /> '. . ' � S/ LU� �F��I/�l�� E-MA�L " ' . <br /> CONTRACTOR AUDRE-SS CITY/ZIP P NE <br /> ./lt�i�DC., l3�'�s.L�c. Zz�8 r�i�N�f�N p �uz r.�,��E�i- , <br /> CONTR.I,ICENSE# ,.�Y./ = i. ! `� �L. I Z�fJ \ 1J L '7' j C� •/��/ . Zt117- �'7� �� t+ CL � <br /> �y �� <br /> USE OF BUILDING HEAT SOU CE CONTRACT PRICE OF WORK <br /> Eleclric �Gas Olher <br /> WORK DESCRIPTION <br /> /-"ic/ .a�-15" ��G7 C�� !�� (C_ j�-CL <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilel A/C-air handlin�units <br /> BathWb Forced air systems <br /> ��� Lavatory(wash basin) � Gas piping <br /> Sliower �_ Water heater <br /> � Ki�chen eink&disposal �_ Gas fireplace <br /> � Dishwasher _� Gas�range � <br /> Clcthes washer �_ Clothes dryer <br /> �_ Waler healer � Rarge hood <br /> � Sink(servicelbadniop/elc.) S Exhausl fan <br /> Backflow preventer � Heat pump <br /> Urinal Unit healer <br /> f _ Drinking Fountain Boiler <br /> Floor drain �_ Refrigeration <br /> Grease irap Woodslove <br /> Roof drains Other _ <br /> Other __ _ <br /> � CITY OF EVERETT LOCAL SALEE TAX CODE IS 3105 <br /> I herehy cerilify lhat I have read and examined lhis application and know lhe same to be true and correcL All provisions of laws and <br /> ordinaces c�overning Ihis lype of work vrill be complied v+ith whether specified herein or not.The grantino of a permit does not presume <br /> to give authority to viotate or cancel Ihe pro � ion of any other state or local law regulating construction or the pedormance ol <br /> conslruc n. Thal I am aulhorized by e vmer o(lhis property to perform ihe work for which applicalion is made and;^.nmply with the <br /> i State C ntractors Law 18`27 RCbV a d 2 6.200 WAC. � <br /> �� �. . 'L � � � <br /> Signalure of OwnedC NractodAuthorized Ngenl Dale � <br /> �/� <br /> L <br /> � <br />