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�..; j <br /> P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVEkETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ` ` 5_ O�i <br /> L <br /> SITE AD�RESS PARCEL TAX I.D.# PERMIT# <br /> - �.^� On�rs �`1URD`3 D/ a. <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> �an�r S tirr�rt���c �d08 Onkes � '�} Ull� 98a0� ya5-��6-'15 ��' <br /> VCr� <br /> TENANTNAME CONTACTFORPERMIT PHONE (��S-g�6_(���-'7 <br /> ) (� -I / <br /> I<(1f�.Y1 f"�YU.�YQ\tIS E-MA�L <br /> CONTRACIOR ES I � HO E <br /> CONTR.LICENSE# �,�v�-i� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Uc:(!� <br /> Eleclric Gas�Olher I <br /> NC�IYIt — — <br /> WORK DE^.CRIPTION <br /> �(�GG t%/S��' ✓'�. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPf:OF FIXTURE OR ITEM <br /> Toilet A/C-air handling unit= <br /> Bathlub Forced air spstems <br /> Lavatory(wash basin) Gas pipinq <br /> Shower \N2ter heater <br /> _ Kilchen sink&disposal Gas(ireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Water healer Range hood <br /> Sink(servicelbar/mop/elc.) Exhausl fan <br /> Back(low preventer Heat pump <br /> Urinal _ Unit healur <br /> Drinkinc� Feuntain Eoiler <br /> Floor drain Refrigeration <br /> Grease trap � Woodstove <br /> Roof drains . Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CJDE IS 3105 <br /> I hereby ceriti(y that I have read and examined this applicalion and Y.now the same to be true and correct. All provisions of laws and <br /> ordinaces goveming this rype ot work will be ccmplied wilh whelher specified herein or noL The granting of a permit does nol presume <br /> to give authority to violate or cancel lhe provision of any other slate or local law re�ulaling consWclion or the per(ormance o( <br /> conslruclion.Thal I am aulhorized by 1he owner of lhis property to pericmi Ihe work(or which application is made and I comply wilh the <br /> Slate Contractors Law 18.27 RCW and 29f.200 WAC. <br /> ���l1^�Q/}� �A' , t�,�,.y.iiillh7 _- ��'��1�� _ <br /> Signature of OwnedConlraclorlAulhorized Agent Date <br /> � — -- <br />