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P�MIT APPLICATIO�� <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 - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# P MIT# n ` <br /> 241Z o�1KE, a�c 439 ( - S50 — vz �- �� �� D� <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. 'Z� 5 GJO <br /> OWNER ADORESS CITY2IP PHONE ZO� `g7.au2' <br /> [I! -.h1 IWI�r ,�„� CR � Yr �412 orqKE� kvf �V�zFmT , w,..l <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> ----- .f I �n S �^-� ��rN 3b�. 5�. 3. 9��7 <br /> CONTRFCTOR ADDRESS CI1Y21P PHONE <br /> /lRK Gvsr+.+� �3�oos g5 iv� ..���e.,< 3�..o. Sd9. 9�?7 <br /> (� o. f3�* <br /> z <br /> CONTR.LICENSE# n �KCv3'L `I`l lJ � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Q��f K �r�2$ _Electric _Gas_Olher <br /> El �D, aD� <br /> WORK�ESCRIPTInN R6P�,��iac. �x isri ,.�c: (Yhn4vE ui ���( 2�' K 2''1' }�c�St/, <br /> ((Itr1µE G�Rrl+.�i �$A�+.ti �,ocAT�orJ�- '�l . — <br /> ,� �, r . �?�l� ��- 0/lo <br /> PLUMBING MECHANICAL <br /> NO. I TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet _ A/C—air handling units <br /> Bathtub _ Porced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clothes washer __ Clothes dryer <br /> Laundry t2y _ Range hood <br /> Sink (service/bar/mop/elc.) _ Exhaust fan <br /> � Backilow prevenler _ Heat pump <br /> , Urinal _ Unit heater <br /> Drinking Fountain Boiler <br /> ' Floor drain _ Refrigeration <br /> Grease i2p _ Woodstove <br /> Roof drains _ Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 1�05 <br /> I hereby ceritify that I have read and examined this applicaUon and kno�v the same to be true and cortect. All provisions of laws and <br /> orainaces governing this rype of work will be compiied with whether specified herein or noL The granting of a permit does not presume <br /> ro give authonty to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> construction.That I am �uthonzed by the owner of,his property to penor�f the�mrk for which aDplication is made and I comply with the <br /> State G"y�nt[actors Law 18.27 RCW nd 2 0200 WAC. B/�o/DY <br /> �,�-...-�- �,� 2�-��C, r r �I� <br /> SignaWre of OwneuContractonAuthonzed�;gent Da[e <br />