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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 U S �b'-D � <br /> SITE ADDRESS I J;�� �L(G'� PARCEL TAX I.D.# PERMIT# <br /> �C�5O�--dZ� <br /> IEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER Lls� .�� A�I�E�S _ CITYIZIP C� _F���� I _ � <br /> � •��`� +,f0 �t�Jl ''�'t� <br /> _�"a1�1 -�•s-r+� ��R�rr' LJ4 �, zf� tyt,clr.� �.�sF`-�n •• <br /> TENANTNAME CONTACTFORPER T PHONE <br /> �Atk1� o.S €�(,•u�l� <br /> CONTRACTOR � �'j�4DDRESS��Q� �,Y CITY2IP PHONE �z� <br /> CONTR.LICENSE# !-'^, ,l L �,^�LCI � " `P � ,T�` _y f,�� � � <br /> 1f`KJ�-��—:73—�:-i 1 r.�� +�� Q <br /> F <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> �f� ����� _Electric _Gas_Olher �2.�� �� <br /> WORK DESCRIPTION ���� � � � <br /> Cr Fav�a-kan � v�e��'re� be �rr.s,l. <br /> �, s� (� �d,�,�� ge��,e. C1 c��-��. <br /> PLU BING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air hand�ing unils <br /> Balhtub Forced air syslems <br /> Lavalop•pvash basin) _ Gas piping <br /> Shower Water healer <br /> Kilchen sinA 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clolhes washer Clolhes dryer <br /> Laundry Ua� _ Range hood <br /> Sink(service/Uadmop/elc.) Exhaust fan <br /> Backflow prevenler Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease trap Woodstove <br /> Root drains Olher <br /> OUiar <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerili(y Ihat I have read and examined this application and know the same to be truo and cortecL All provisions of laws and <br /> ordinaces governing this lype of work will be complied wilh whother specified herein or noL The granling of a permil does not presume <br /> to give aulhorily lo violate or cancel lhe provision of any olher stalo or local law regulating c_nstruction or lhe peAormance of <br /> consUuction.Thal I am aulhorized by lhe owner of lhis property to pedorm lhe work for whi���i application Is made and I comply wilh lhe <br /> Slale Conlract Law 18.27 RCW and 296.200 WAC. <br /> � <br /> Signalure o wner/ o ac or/A thoriz d Agent Date <br />