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� PERMIT APPLICATION <br /> �I CITY OF EVERETT PERMIT SERVICES <br /> � 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED PROM 8 AM TO 4 PM � —3 � �(J� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# I <br /> � I� <br /> � ��2 � oq i� ��Ir oo't,3�a S3�z�oo ,���i�� , � �� <br /> LEGAL LOTNO. gLOCK TRACT � <br /> I DESC. <br /> � OWNER ADDRESS CIN/ZIP PHONE �, <br /> �;�SCY �('�ic� 3'iz`f �,�-u�rL �vc� e'�,c�2e�r�i�� �>� �J y �—(��Z� <br /> I TENANTNAMe CONTACTFORPERMIT PHONE <br /> l�F�+.� 7�'6- `I/z - 33 �l? <br /> CONTRACTOR ��vt �`�F��— CCL ADDRESS CINIZIP PHONE ; <br /> � �'��� ZZof`J•; 5�,� y- � Qyos`/� '�7T• �� �/J� ��, <br /> I CONTR.LICENSE# ��LU���� y��� / <br /> � /Llc i� L.,A ��Z 1 .i.'7 � i <br /> USE OF BUILDING — HEAT SOURCE � CONTRACT PRICE OF WORK ; <br /> � � �ZS"� I <br /> Electric ✓ Gas_Other i <br /> WORK DESCRIPTION I <br /> (�:'I7' �'Jii� 'l2' �v,�hAcZ` 1 1� � ,cfc/rt�R <br /> PLUMBING MECHANICAL ' <br /> � NO. TYPE OF FIATURE OR ITEM NO. TYPE OF PIXTURE OR ITEM � <br /> I <br /> Toilet AIC—air handling units <br /> _ Bathtub Forced air systems <br /> I = Lavatory(wash basin) 2 Gas piping <br /> Shower Waterheater <br /> _ Kitchen sink 8 disposal _ Gas fireplace ' <br /> I _ Dishwasher _ Gas range I <br /> Clothes washer Clothes dryer , <br /> �I _ Laundry tray _ Ra�ge hood <br /> Sink Iservicelbadmopletc.) Exhaust fan �I <br /> _ BackOow preventer _ Healpump <br /> . _ Unnal Unit heater <br /> _ Dnnking Fountain Boiler <br /> � __ Floordrain Refngeration I <br /> '� _ Grease trap Woodstove , <br /> �I Roof drains Olher _ � <br /> Other � <br /> �I CITV OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> li I here5y ceritify that I have read and examined this applicalion and know the same to be irue and correcL All provisions of laws and <br /> i, ordinaces governing ihis type o(work will be complied with whether specifed herein or not.The granting c`a permit does not presume <br /> �� to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> consiruction. That I am authonzed by the owner of this property to perform the work for which application is made and I wmply with ihe <br /> ; State Contractors Law 1827 RCW and 296200 WAC. �, <br /> '� �i' <br /> -�---- !-3v-ar <br /> � Sig aWre o(OwnerlConlractor/Authonzed Agent Date <br /> I� ------ - - - ---- -- ---- --- �I <br />