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. � <br /> PERMIT APF�LICATION <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 PARCEL TAX I.D.# ?ERMIT N <br /> 2�Z0 �Jh ' o�' Ob'� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PNONE <br /> Nae.� C�z��/--�d•�s C�/u�3 2L�c� �K.� �; �&u�/ <br /> TENANTNAME CONTACTFO�R iERMIT PHONE <br /> (�4Eo p�(-t�c ��-S��4u�td�i I�EJ.� �l�v � �fZS) 2SZ-3f 1�{- <br /> CONTRACTOR ADDRESS CITY2IP N <br /> E�E�� 5��;� N��-� a/� Z�zo t�;�'� �,�r- �zai l��g�sZ-3���- <br /> CONTR.LICENS�����^�O ZZOT� <br /> !O <br /> USE OF BUILD�II G HEAT SOURCE CONTRACT PRICE QF WORK <br /> t r���� _Eleclric �Gas_Other `g�� � <br /> WORKUESCRIPTION KEp,�c� Ex�snxe S T� �'� w�Tn ' N�� � � u� <br /> � Ck(5'�"fIJ(3 /O TON I�Tu <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR REM <br /> Toilet 1 A/C—air handling units <br /> _ Bathtub Forced air systems <br /> Lavatory(wash basin) � Gas piping <br /> Shower Waler heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwashcr Gasrange <br /> Clothes washer Clothes dryer <br /> Laundry Iray Range hood <br /> Sink(service/bar/mop/etc.) � Exhaust fan <br /> Backllow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Re(rigeration <br /> Grease trap Woodstove <br /> Roo(drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby ceriti(y that I have read and examined this application and know the same to be true and correct. All provisions of laws ar�t <br /> ordinaces goveming this type o(work will be complied with whether specified herein or noL The granting of a permit does not presurt.e <br /> to give authority to violate or cancel the provision of any other state or local law regulating construclion or the peAormance of <br /> consiruction That I am aud�orized by ihe owner of this property to pedorm the work for which application is made and 1 comply with the <br /> State Cp n/tr�ctors Law 1 R nd 29B"2�0 WAC. <br /> ���� � �� 7-�-a�7 <br /> Signaturo of Owner/Coniractor/Aut ed Agent Date �� <br /> Z <br />