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PEKMIT APPLICATION <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 �� � �V -�7 <br /> SITE ADDRESS I PARCEL TAX I.D.# PERMIT# <br /> j d�, �Ce S rn2� �3 7b�`��� <br /> LEGAL LOTNO. BLOCK TRACT <br /> OESC. <br /> OWNER � ADDRESS CITY2IP PHONE Z�jV"]"j'�jZ <br /> �SSIZ I�D�SOf� �bLl�l ��ufces r�v� �v�-Ce E�� W/� `�P � l <br /> TENANT NAME � � CONTACT FOR PERMIT PHONE <br /> �� f�� � SJI\ 2-�� �2� � `�5� <br /> CONTRACTOR ADDRESS CITY2IP PHONE z�� -��� zy �� <br /> (�or1.�r- pi.JrJ�?Z <br /> CONTR.UCENSE N � �CO/ G'���� '� �'e /_'CG�r� � C✓�¢ �7�?D / <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> 2t,,� ��; ,,(�h l _Electric �Gas_Other �P ���O <br /> WORK DESCRIPTION /+ <br /> �r` Si--�-.'^ c,\ �.)tr^P: In f.�pa.E C�'�, InJJ'aiC' -li: Ol��aw- � c.nnS4+v`c�Ult. <br /> V <br /> �/ (i. /wt�l'n>7 [VlfC..F— .�O�nJL_r /� /P�+Int�✓it, � �1�1 GN./s iKl-� i-�K��tj A¢ �.1 <br /> _1 .� <br /> .af�:�0:..� ) �Z) . �J 5N✓c{.p•�l ctia�r)P5 . ior.'11�.�0_ u1.1� be I+ �i- �..�'4-acf . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A!C-air handling units <br /> Bathlub Forced air syslems <br /> Lavalory(wash basin) _ Gas pipinc� <br /> Shower _ VJater heater / <br /> Kilchen sink&disposal `,� _ Gas fireplaco ^J/f�1 <br /> Dishwasher N / Gasrange <br /> Clolhes washer Clolhes dryer <br /> Waler healer Range hood <br /> Sink(service/bar/moplelcJ _ Exhausl(an <br /> Backtlow preventer _ Heal pump <br /> Urinal Unit heatar <br /> Drinking Fountain _ Boiler <br /> Floor drain RefrigeraUon <br /> Grease trap _ Woodstove <br /> Roof drains Other <br /> Othcr <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> I hereby cerilify thal I havo read and examined lhis application and know lhe same to ba true and correcL All provisions of laws and <br /> ordinaces governinc� lhis lypo of work will be complied wilh whelher specified herein or not.The granling of a permit does nol presume <br /> to c�ive aulhoriry to violate or cancel Ihe provision of any olher state or Iocal law regulating consWclion or the pedormance of <br /> conslruclion.Thal I am aulhorized by tho owncr oi lhis property lo perform lhe work for wnich applicalion is made and I compiy wilh the <br /> Slate Conlraclors Law 18.27 RCW and 296.200 WAC. <br /> ���� ��/�� � � <br /> Signature o(Own�Contr�lor/Authonzed Agent ate �,� 1 <br /> J <br />