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PrRMIT APPLICATION <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 <br /> SITE ADDRESS ��� �I eQ�e✓ w�tY PARCEL TAX I.D.# PERMIT p <br /> �6�C:�'B/ - �(�� /0�3 �� <br /> LEGA LOTNO. BLOCK TRACT <br /> �ESC. <br /> OWNER � ADDRESS CITYIZIP PHONE <br /> riRkGLG�� /�/�SGL� �1��1 f�e���je✓ �✓Ccy� �✓e,Pef�, `��ZD� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> /58/S Adm�ra/t U/c2 <br /> CONTR.LICENSE# GASP.I P�+A�s�KO y (y2s)�2 -3��. <br /> ,L/�7nu�DOt� � !1//� 98 �� <br /> USE OF BUILDING � HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Other <br /> WORK DESCRIPTION C�G f /?�/7L_ /!7 S �2 ��CZ f/ F�'J 7E��C� �/j'R/J�Ct' � L1lJ/ Cl/Q �� T(�l.�C / <br /> ���u,��� �y'y�er , <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling unils <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kilchen sink 8 disposal Gas fireplace <br /> _ Dishwasher � Gasrange <br /> Clothes washer Clothcs dryer <br /> Laundry tray Range hood <br /> Sink(serviceNadmop/etcJ _ Exhaust fan <br /> Backflow prevenler _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeralion <br /> Grease trap Woodslove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX COUE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know lhe same to be true and cerrect. All provisions of Iaws and <br /> ordinaces governinc�this type of work will be complied with whelher�pecified herein or not.The grenting oi a permit does not presume <br /> lo�ive aulhorily to violate or cancel lhe provision of any other state or local Iaw regulaling construction or the performance of <br /> construclion.That I am authorized by lhe owner o(this property to perform the work tor which application is made and I comply with the <br /> State Conlractors Law.t8.27 RCW and 296.200 WAC. <br /> �-�;==-�= -�____ 9 /i3 %o � <br /> $ignaWrC o Cri"vnedContractor/Authonzed Ac�ent Date <br />