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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -wwv+.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM s _I y..,� <br /> SITE A�DRESS PARCEL TAX I.D.p P RMIT# <br /> :��U,-� �o5t C-�rar�t Ave . �0 �05-OC'i`f <br /> LEGAI LOT NO. BLOCK TRACT OR SU9DIVISION p <br /> DESC. <br /> OWNER I ADDRESS �^ CITYIZIP PHONE <br /> Norrna�� f lC�� lfiL �� r �C'��� ZJU�. L�.1`�f 11fZ�-f�� �UP CV�r�{-f Ct�52.CJ � <br /> �12J'2t�2' �1:J I � <br /> TENANTNAME CONTACTFORPERMIT PHONE�i2j_�,5'L-7��-'I� <br /> l�L�r� C' L(Y�`�--'rl� E-MAIL�r�f�� IOG�I�G1IlW.0 M <br /> C TRACTOR D 5 � �P <br /> CONTR.LICENSE# �I F <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> [lectric Gas Othcr <br /> WORK DESCRIPTION ��� .�`, ,JI G� �}L�C� �< <C'_ <br /> PLUMBING MECHANICAL <br /> NO. TYPE Of FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handling unils <br /> Dalhtub Forced air syslems <br /> Lavalory�wash basin) _ Gas piping <br /> Showcr Waler healer <br /> '< Kilchen sink&disposal _ Gas fireplacc <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Water healer Range hood <br /> Sink(service/bar/mop/elc.) _ Exhaust fan <br /> L�acklbw preventer _ iieat pump <br /> Urinal Unil healer <br /> Drinking Founlain . _ Boiler <br /> Floor drain Refric�eralion <br /> Grease Irap _ Woodslove <br /> Roo(drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J705 <br /> I hereby ceriti(y thal i have read and examined this applicalion and know the same to be true and correcl. All provisions of laws and <br /> ordinaces goveming lhis lype o(work will be complied v+ith whether specitied herein or not.The granting of a permil does nol presume <br /> to give aulhority to violale or cancel ihe provision of any olher state or local law regulatinc�consWction or lhe performance ot <br /> construction.Thal I am authorized by the owner ol this property lo peAorm the work(or which application is made and I comply with the <br /> Slale Conlractors Law 18.27 RCW and 296.200 WAC. <br /> ,��t'LGGtO -A .�1JI��-�� � •/2'(��J <br /> SiynaWre o(OwnedContraclodAulhonzetl Agent Date <br />