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� , <br /> PtRMIT APPLICATIUN <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 /> /O (Z� APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �(,'V SI,� -3� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT S <br /> Ica rne,n��:c.�,� q�� rx� 3�iG�xxx�s6oc� L S/� - . <br /> LEGA LOTNO. BLOCK TRZACT �p -� <br /> oESC. .� %>fDc.G�I:-Z: l�YraS� I��a1— �C� — O S <br /> OWNER ADDRESS CITY/ZIP PHONE 9 <br /> ��rtu.•+ ��,����.�w� .�',� . �KlS 17� '~ /�� ,vc ,yu��,vws[� `1'8�� <br /> TENANT NAME CONTACT FOR PERMIT PNONE <br /> '; <br /> ' � Tcas� - {��s� �• � �IZS-�)8-oy!l? - <br /> COt�TRACTOR 1 ADDRESS CITY2�P PHONE <br /> ��>f ruwt �u�15��L1��'rM .L'wC . 1 t�l � 1")l*� �A+� " .N.� S�tp�,�rj�n��S 1-� �.�1/1- <br /> CONTR.LICENSE# � � : `' � ' ' ���'(U <br /> l�Cr:kv�n G�-`l l SQ(o <br /> USE OF BUILD!S�G HEAT SOURCE CONTRACT PRICE OF WORK <br /> S� �Z I _Electric �Gas_Olher <br /> WORK DESCRIPTION <br /> �eW �IJnS��:'}�vtN� Sr 12 � � � V <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilet A/C-air handling units <br /> ^ � Balhtub = Forced air systems <br /> Lavalory(wash basin) .�,_A1 Gas piping <br /> � Shower �_ Water healer <br /> � Kilchen sink 8 disposal Gas freplace <br /> � Dishwasher Gas range <br /> Clothes washer = Clothes dryer <br /> a er eater - Range hood <br /> serviceNadmopletc.) Exhaust tan <br /> Backflow preventor Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boller <br /> Floor drain Refrigeralion <br /> Grease trap Woodstove <br /> Roof drains Olher <br /> Olhor <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby cerili(y thal I have read and examined this application and know Ihe same to be true and correct. All provisions o(laws and <br /> ordinaces governing this type of work will be complied wilh whether specified herein or nol.The granling of a permil does not presume <br /> lo give authority to violate or cancel lhe provision of any other state or local law regulaling wnslruclion or the perfo�nance of <br /> construction.That I am aulhorized by the owner oi this property to perform the work tor which application is made and I comply with the <br /> Slale Conlractors Law 18.27 10/-aa 96.200 WAC. <br /> / "- //-a y-vs <br /> Sig�ure of Own raclor/Autho ' ed A e Date <br /> ��2 <br />