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PErtMIT 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 3-. o�-�5 <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT S CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT �i <br />��/l ��E� �+vc D� �fl ��-f O000 � 3o t �' 'Sbl -�-�`" <br />LEGAL LOT N0. BLOCK TRACT n� Jf 0 m A,.� IN E A"� �FS <br />DESC. � 3 (JG� �— U I � ��K <br />OWNER ADDRESS CITYIZIP PHONE illr <br />�,,�L�D� k ����N�crr+,h� ��ll �C��/�� ��s�3�.� ar 3�t3-S93�� <br />TENANT NAME I CONTACT FOR PERMIT Zn1=�NE y1S <br />� S'8 - }qsz <br />CONTRACTOR.J..12� yt72S�� CO�S�yDDRF,SSG L1��"2 ��TMMUkiLtFooNe 4'�S <br />��.��- L:' 3`l�i -l�-fSl <br />»tr�a E V I E w Q;� �l g,� }S <br />CQ4TR. LICENSE p , � %_ \ <br />USE OF BUILDING S� 2 <br />HEATSOURCE <br />_ Electric � Gas _ Other <br />CONTRACT PRICE OF WORK <br />'� l�O, D��"'��� <br />WORK DESCRIPTION <br />/2�n�luc(tG' /�tl� �2an��� o✓'r-'- e°x�.CfYNS �y��ase. F,aIqR;•G f� <br />%�.�Drn ��c'a�)/irx( k� tcLiP,� l.,.��( C�;N;,�.�� i2ouvh , u!(c��/�ns,s� �l.�r:� S�l�.�I� <br />���<�. Nt,.� d����. <br />PLUMBING MECHANICAL <br />NO. I TYPE OF FIXTURE OR ITEM <br />Tailet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Laundry tray <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floar dr2in <br />Grease trap <br />Roof drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />A�C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer �,/ ��n` � <br />Rangehoad. ebt{vMtticlUL��J/�ZTTT <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Waodstove <br />Other <br />� CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />a�tt.c. <br />' I hereby ceritify thai I have read and examined this appiication and know the same to be true and correct. All provisions of laws and <br />ordinaces goveming this rype o( work will be complied wi6i �vhether specified herein or not. The grantirg of a permil does not presume <br />' to give authoriry to violate or cancel the provision of any olher state or local law regulating construction or the per(ormance of <br />� r.onstruction. That I am authorized by the owner of this property to perform the work for whir,h applica[ion is made and I comply with the <br />State Contrac;ors Law 18 � R�IN and 296.200 WAC. <br />.! i/ �' ��//' G� %Z��G�� <br />'/Z <br />