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I��RMIT APPLICATII,N <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 `1 PARCEL TAX I.D.# P M�IT1 /t��c� \ <br /> � ���J �� '{�h/�f7 �UC 'j��0�14iD 'U`100q� � / �/" ��1. <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIYISION B <br /> oEsc. 5Et R�PG�1C U <br /> OWNER ADDRESS CITY2IP PHONE <br /> a�.Er.;� � N�i��.�A ���nnt���� �5�5 �Kr.�b av� �����n,4�fi �iZ5- �9o- 6«g <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> 8�,��-� ���r,��;� 915- �q�- %�14 <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> UF�J ,�.qc{% A55ac�fi�t��,, I�JG. Po �x 1306� c v&�sl�, 6J�+ `1Z� -2�U"�'�912. <br /> CONTR.LICENSE# � <br /> �F.ti_,l�I p2\ Do <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> 'S 1' k� _ElecMc �,Gas_Other <br /> WORK DESCRIPTION <br /> �y�,j ��lOV7,�� QU`� R� l0� <br /> /11�1?� F L°�oQ� ��,+JC� '�i C101.�. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF PIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 2 Toilet AIC—air handling units <br /> Bathtub � Forced air systems <br /> �_ Lavalory(wash basin) _ Gas piping <br /> �_ Shower _ Water heater <br /> �_ Kitchen sink 8 disposai Gas Tireplace <br /> �_ Dishwasher _j_ Gas range <br /> �_ Clolhes washer �_ Clolhes dryer <br /> Water healer �_ Range hood <br /> �_ Sink(service/bar/mop/etc.) _� Exhausl(an <br /> Backflow preventer _ Heal pump <br /> Urinal Unit heater <br /> Qrinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease lrap _ Woodstove <br /> Ro�f drair.s Other <br /> Olher <br /> CITY UF EVERETT IOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify thal I have read and examined this applicatiori:�d know the same lo be lrue and correct. All provisions ot laws and <br /> ordinaces governing lhis type o(work will be complied with whr:�ner specified herein or not.The granting of a permit does nol presume <br /> to give authority lo violate or cancel the provision o(any olher slate or local law regulating construcGon or ihe perfortnance of <br /> conslruction.Thal I am authoriz�by tre owner of,lhis property to periorm lhe work for which application is made and I comply with lhe <br /> Stale Contraclors Law 1 .27 RC an 2 Fb200 WqC,\ <br /> y I <br /> ��lr'od ��'C14i�_� _O��- �� -�1�- <br /> Sionature of OwneNCon ctodAu _ �g nl' � Date <br /> , \ ' � <br />