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PE�MIT APPLICATIOIv <br /> 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 FROM 8 AM TO 4 PM 1 a � a � � D� <br /> SITE ADDRESS PARCEL TAX I.D.# P RMIT# <br /> > n , - d ���� �I�'I - ;c - i - c�o� �G�//�/ <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. iq ��� ��K ODO - !>DD <br /> OWNER ADDRESS CITY2IP PHONE (N��) <br /> it;�\', Lv�al}s-f5 31�1 1�«.�h�r ro�d E'vcrc� 9YZo3 as�-7a�s <br /> ��i}CN�C` Gn� 11 PHONE <br /> TENANTNAME CONTACTFOft PERMIT <br /> � l�f��% W�lls�s yas-�ss-y3ar <br /> ADORESS CITY2IP PHONE <br /> CONTRACTOR ��h��n�� (�'p���ti��j ,Ja)_ <br /> ( / p -/ <br /> CONTR.LICENSE# j:��'IL�PLCfJ1 �IPl"� Z //J /����lr /� C//t'/�LZ ��/zd3 ,�/s-�J003 <br /> J 7 <br /> USE GF BUILt�.!":i; I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> � Electric G 3s�Other '��,Q��l <br /> —�S i�G,.�'il�' — — ' <br /> WORKDESCRIPTION � • / � � � ��'3�D <br /> �U�r4Um t�H ✓7 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> � Toilel _ NC-air handling units <br /> � Bathtub _ Fo•ced air systems . � I <br /> � Lavatory(wash basin) _ Gas piping �L�� <br /> f Shower _ Waler healer � � <br /> Kitchen sink&disposal _ Gas fireplace (�� <br /> Dishwasher _ Gasrange � <br /> Clolhes washer _ Clothes dryer 5 <br /> Water healer Range hood � <br /> Sink(service/badmop/elc.) � Exhausl fan <br /> Back(la�v prevenler _ Heat pump <br /> Urinal _ Unit healer <br /> Drinkinc� Fountain _ Boiler <br /> Floor drain _ Refrigeration <br /> Grease trap _ Woodslove <br /> Roof drains _ Olher <br /> Olher — <br /> CITY OF EVERETT IOCAL SALES TAX CODE IS 3'105 <br /> I hereby c�r!i(y thal I have read and examined this application and know lhe same to be true and correct All provisions of laws and <br /> ordinaces govarning lhis type of work will be complied wilh whether specified herein or nol.The granting of a permil does not presume <br /> lo give avthority to violate or cancel the provision of any oiher state or local law regulating construction or lhe pertormance of <br /> construction.That I am aulhorized by the owner of this properly to pertorm the work for which application is made and I comply with lhe <br /> Stale C�n ctois Law 18.27 RCW and 296.200 WAC. <br /> � ��-/'D(o �(` <br /> Signature of OwnedContracror/Authorized Agenl Dale <br />