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P�RMIT APPLICATI�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 ��J�- � <br /> SITE ADDRESS I �J(S ��f"� PA.RCEL TAX I.D.# PERMIT il <br /> � � <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER �,Q���1�-�.. A�I�� CITY2IP ��PI E��� �� <br /> —7�r�-.--� � �t�! <br /> _�.'�� � """`s �rba�rt` LJ4 �'.��lc� 1• <br /> TENANT NAME ~ I CONTACT FOR PER T PHONE <br /> �� �5 ��� <br /> CONTRACTOR ^ '�' ,-�-�DORESS p�Q� � CITY/ZIP PHONE � � <br /> v���� ( ��'�.' �/�Q ����� " '�� <br /> CONTR.LIGENSE# � .1 n � �/ t���L.�Lf� ��' �p,��`��� <br /> �LfJ�{.I'vc�c� _ �ji 1 <br /> USE OF BUILDING HEAT 30URCE CONTRACT PRICE OF WORK <br /> �N ���� I _Electric _Gas_Other � `�� � <br /> WORK DESCRIPTION De1Y� � � ,� <br /> (�- F�zv�a-(Ya� • re�d�rre� be w,�r�d. <br /> C( 5��(� �'a�,�� ��,e C1 a���. <br /> PLU BING MECHANICAL <br /> NO. � TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ A/C-airhandlingunils <br /> — 8������� _ Forced air syslems <br /> _ Lavatory(wash basin) _ Gas pipinc� <br /> _ Shower 1�� _ Waler healcr <br /> Kilchen sinA&disposal �� _ Gas fireplace <br /> _ Dish�vasher \�� J(` _ Gasrange <br /> Clothes washcr rO _ Clolhes dryer <br /> Laundry lray ���' � _ Range hood <br /> _ Sink(;.arvice/bar/mop/etc.) '1\' � � _ Exhausl fan <br /> Backflo�v preventer •,'1, _ Heal pump <br /> _ Urinal 1 I _ Unit heater <br /> Drinking Fountain _ Bailer <br /> Floor drain _ Refrigeration <br /> Grease lrap _ Woodslove <br /> Roof drains _ Olher <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y lhal I have read and examined lhis app�icalion and know the same to be Iruo and correcL All provisions of laws :�nd <br /> ordinaces c�overning th(s type ot work will be complied with whether specified herein or nol.The granting oi a permit does not presume <br /> to flive aulhority to violale or cancel the provision of any other state or local law reguiating construction or the pedormance of <br /> construction.That I am aulhoriz �d by the owner of this property to pedorm lhe work for which application is made and I wmply with the <br /> State Cont ctors Law 18.27 RCW and 29G.200 WAC. <br /> �.�.�.� ��f��� S�ul�� <br /> Signaluro o( w � ContractodAuthonzed Agent Date <br />