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_ � �- <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 ,ag� <br /> 425-257-8810 — FAX 425-257-8857 —www.everettwa.org ���� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DE81T 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRES�Sy� I PARCEL TAX I.D.N P RMIT• <br /> �0/3� 1 vl�)�'f; w� llG, ��?fl�iGl C�C+O'?� Gp — /� <br /> LEGA LOT NO./ BLOCK TRACT �� ^— �� <br /> DESC. `� <br /> OWNER ApDRES CITY2IP PHONE 'IS <br /> �t.�1,��1�1� /�vAb� C�a�. �n� _ t� ��k��� r�U�, l-�� a3�-3ysa <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> CONTRACTOR �[�IO/� CO/�S'�i�. -h/�G. �DRESS ._�� �Fjk"�a£Jj CITY IP PHONE aS <br /> ��u'�,, u�U a_3�_���. <br /> CONTR.LICENSE N ^'1U IU�,^U � 1 OS �Da�S <br /> /-i� <br /> USE OF BUILDING MEAT SOURCE I CpN�TRACT PRICE O ORK <br /> �-f�m 4� S�� <br /> S�, n.�'� �-��M�� I�i ��S _Eleclric �( Gas_Other ��� p� — /��p q�D <br /> lr <br /> WORK DESCRIPTION 2G�;�/.5 - <br /> ��� 23i,� �r�, � ) fo� <br /> 20 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYpE OF FU(TURE OR ITEM <br /> Toilet A/C-air handling units <br /> ' Balhtub � Forced a(r syslems <br /> Lavatory(wash basin) 4-� Gas piping <br /> /� Shower � I Water heater <br /> � Kitchen sink 8 disposal J_ Gas(ireplace <br /> I Dishwasher � Gasrange <br /> � Clothes washcr Clothes dryer <br /> _ Laundry tray I Ranc�e hood <br /> _ Sink(service/bar/mop/elc.) � Exhaust(an <br /> _ Backflow prevenler Heat pump <br /> _ Urinal Unil healer <br /> Drinking Founlain Boiler <br /> _ Floor drain Refriqeration <br /> _ Grease trap Woodstove <br /> Rool drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TA7C CODE IS 1705 <br /> I hereby cerilify that I have read and examined this application and know the same to be true and correcl. All provisions of laws and <br /> ordinaces govermnc�this type o(work will be complied with whether specified herein or not.The granting of a permil does not presume <br /> lo give authority lo violalo or cancel the provision ol any other state or local law regulating constructlon or the performance of <br /> construction.Tha! I am aulliorized by the owner of lhis property to pertorm the work(or which application is made and I compy with the <br /> State Conlractors Law 18.27 RCW and 296200 WAC. <br /> `��--4 �,0� �i -/S-C� - <br /> Si�naWre o(OwnodContractorlAuthonzed Agent Date �r <br /> /l�� 29Z�9 9�'Z�� z <br />