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PERMIT 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.# PERMIT A <br /> / .(''i/(! a�is ��GSI ' D 0 �00 CD� �'d0�- <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION p <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> �'I��,� ; 1�,� 1�c� ,� io� � Guk�s ,� �etf 98aoi <br /> TENANT NAME CONTACT FOR PERMIT PHONE t�as. ��7,. �S�S <br /> � I / �/ /��/ S ��17(�F KC CSl°.() M E-MAII <br /> L��fSCti� ��L'NJ7 Id9a7 �. C-,��s�n (��' �= io� ��e�Et1 98�oY aas-3a7. ,�s3s <br /> CONTR.LICENSE�l � ^ � ,5 C C .T. I D� D �'! <br /> /t <br /> USE OF BUILDING I HEAT SOURCE � CONTRACT PRICE OF WORK <br /> A f �Electric _Gas_Other 7�QQ �c <br /> �f�,�i�T4i���( r <br /> WORK DESCRIPTION ' I ��,� � ����,_L jF\ <br /> �l'� � f c'�'naC�C ( I 1✓�u.' L � <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ A/C—air handling units <br /> Ballilub _ Forced air syslems <br /> Lavatory(wash basin) _ Gas piping <br /> � Shower _ Waterheater <br /> Kitchen sink 8 disposal _ Gas tireplare <br /> Dishwasher Gasranr, <br /> � Clothes washer �_ Clolhes dryer <br /> Water healer Range hood <br /> Sink(service/barlmop/elc.) �_ Exhaust fan <br /> Backflow prevenler _ Heal pump <br /> Urinal _ Unil heater <br /> Drinking Fountain _ Boiter <br /> Floor drain _ Refrigeration <br /> — Woodstove <br /> _ Grease trap Other <br /> Roof drains <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceritify that I have read and examined lhis app�ication and know the same to be true and correct. All provisions ot laws and <br /> ordinaces governinc�this type ot work will be complied with whelher specified herein or not.The granting of a permil does nol presume <br /> to give aulhorily lo violate or cancel the provision of any other state or local law regulaling construclion or the pertormance of <br /> construclion.Thal I am aulhorized by Ihe owner o(this property to perform the work(or which applicalion is made and 1 comply wilh the <br /> State Contraclors Law 18.27 RCW and 296.200 WAC. <br /> �,�i/! � �/(� �.�.� 7— n7 <br /> c ���, _-s. <br /> Signature ot wnedContraclorlAulhor¢ed Ac�ent Date � <br /> L <br />