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P�RMIT APPLICATIVN <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 PARCEL TAX I.D.�k PERMIT# <br /> " d G�k. � �la..c<< - c � ) <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS �8�ITY21P PHONE <br /> 3 <br /> �UY��1 (�\1 Q v� I S��t P c.r Ic (�✓ E�tert,J.� 4 zs"• �S'z - �trG s <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> �N1 VY iC� r���e.11 <br /> CONTRACTOR K��„� �y ��y��,S ADDRESS CITY2IP PHONE <br /> qo2L" v wi¢.�dut,�y C..kl[.� 0�( ;?(op• S6 8- v162 <br /> CONTR.LICENSEA KA�� E H� aG(o P <br /> 9 S�ti�N•�.rl. l,�l q 5'2 zt m <br /> USE OF DUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric ✓Gas Other � e o o, � <br /> WORK DESCRIPTION <br /> ln.t+c U C�as �':rG � k, ct ���e.e sJ-c..d ;..C\ <br /> �1J <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavalory(wash basin) � Gas piping <br /> Shower Water healer <br /> Kilchen sink 8 disposal � Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Ciothes dryer <br /> Waler heater Range hood <br /> Sink(service/bar/mop/etc.) _ Exhausl fan <br /> Back(low prevenler _ Heal pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roo(drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> I hereby ceritify thal I have read and examined this app�ication and know the same lo be true and correct. All provisions of laws and <br /> ordinaces governing this type of worh will be complied wilh whelher specified herein or not The graNim�of a pertnit does not presume <br /> to give aulhoriry lo violale or cancel lhe provision of any olher state or local law rec�ulaling conslrucUon or lhe peAormance of <br /> conslruclion.Thal I am authorized by Ihe owner of lhis propeAy to periorm lhe work for which applicalion is made and I comply wilh the <br /> Slat ontractors Law 18.27 RCW and 296.200 WAC. <br /> . � _ � <br /> � V'a cl- l �' o` <br /> Signalure of OwnedConU tor/Aulhonzed Agent Dale <br /> I�� <br />