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� � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIZ 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 � _a� �-� <br /> SITE ADDRESS PARCEL TAX I.D.il I P RMIT# <br /> �,oc� ���u.d ,���. �� �f5o��a <br /> L[GAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS � CIN21P PHONE <br /> 6ii�� r• S�e �TGi� �3Lc3 �JOOhw0..� „zk R�. �OCe - �l(�1 �y���� <br /> c.�ccn/w�, wa `/JlS2� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> Sk� l�4-�,� 3 u ����- I 3ae���- Killosg yas 73�� $�'� <br /> CONTRACTOR(r�QS�Pk�! �t�+�s F�c � cfrc%�� CoADDRESS ')102 (�SO ql� �E CITYIZIP PHONE Yal kJ'� D/O6 <br /> A-IOS <br /> CONTR.LICENSE# R�d�nu+d; �1 `{ycs,z <br /> (.�ECrE,SF i ; i. vc <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ����i �-�����- _Electric _Gas_Olher <br /> WORKDESCRIPTION i,JjFl� `� ���d (<,�Q Guw �� ��R� KkIa.� S`? s'�cWt �}ciz <br /> �^F/�� /3 f Cc��o�/�J�--�s t�c� -,;�fs�ut� O,L'—kla=P,4–[.7 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal ,_ Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Cblhes dryer <br /> Laundry Iray _ Range hood <br /> Sink(servicelbarlmop/etc.) _ Exhausl fan <br /> Backflow preventer _ Heal pump <br /> Urinal Unil healer <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> _ Grease lrap Woodslove / <br /> Roo(drains (� Other � Fi��K <br /> Other _ <br /> CI1Y OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby cerilify Ihal I have read and examined this applicalion and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type ot work will be complied with whelher specified herein or not.The granting of a permil does not presume <br /> to give authority to violale or cancel Ihe provision of any olher state or Ioca�law regulating construction or the performance o( <br /> construction.That I am authorized by lhe owner o(lhis prooerty to perform the work for which applicalion is made and I comply wilh the <br /> Slate Conlrac�ors Law 16.27 RQW,and 296.200 WAC. <br /> � ` � i -� cJ <br /> �� � "�'j . %,/a S " S�' � fl <br /> Sic�n2tUr o(Own�t/Contrac lhonzed Agent Date � � <br /> � <br /> r • .- <br />