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/ V —� � `�? <br /> I— <br /> � PEr2MIT APPLICATIO�� i <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> � 425-257-8810— FAX 425-257-8857—ww�v.everettwa.org <br /> + APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED , <br /> i <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> � c -� 'I �c �e � KG"IIU- vIL <br /> � LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHON ��ZS <br /> ��E �t1� �CD Qac�Fii. Ave E✓�re�t,�+:'A �13'zD� z�� - zcoo <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> 1i i� p��n ZeSnurr�s ��CN r�l���h ��IZ5� J��'- ��Z� <br /> CONTRACTOR , ADDRESS /'C i3 CX �II D CITY2IP PHON���s� <br /> f���rl✓5 �if�C Sc Stcrv�s �N� �• � <br /> CONTR.LICENSEp. CZ��UII�C �0.��S 35,- CIZk <br /> l�I1R�J,S FS�2�1�3 �ISl.Sz <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � Electnc Gas Other � � �— <br /> ���nl�C FFi�c $�uce — — — ���L <br /> WORKDESCRIPTION j��„p�„¢ ,,,�newE� to- Pr�Z*dI'(d f,�.t�1N� •a��rh��t �G9,�uc�C. !�] y('+�f.��ti �:•sG- � <br /> l,c r«zl�u�t �i� Uz r��gYc�-d,�.{,. <br /> � <br /> � PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. � TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling unils <br /> Bathtub Forced air systems <br /> Lavatory(v+ash basin) Gas piping <br /> Shower W ater heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(servicelbadmop/elc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> � _ Urinal _ Unit heater <br /> Drinking Fountain Boiler <br /> i Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drainc Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3'105 <br /> I hereby ceritify thal I have read and examined this application and know the same to be true and correct. All provisicn�of laws and <br /> r.roinaces governing this type of work will be complied with whether specitied herein or not. The grenting of a permil does not presume <br /> ;o give authority to vtolate or cancel the provision of any olher state or local Izw regulating construction or the peAormance of <br /> cor,struction. That I am authorized by the owner of this property tc perform the work`or which application is made and I comply with the <br /> �;ate Contrac.ors Law 18.27 RCW and 296.200 WAG <br /> r'7 r���'�.�,�i�a-��u�tit- �v/z5/��' '? � <br /> Signat e of OwnerlContra or/Authonzed Agent ate I <br /> �I �'I <br />