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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 C[DAR STREET, EVERETT, WA 982D1 <br /> 425-257-8810 - FAX 425-257-8857 -www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PflRMIi#� <br /> /�r� �SQ¢i((� Q� O Z 00 Ll DO �Cj Lr '.� - �. <br /> w�- YFl <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP L PHON ��� <br /> n���-�-- �P��i�- +�w�,��s �� ��a�s'T`/ sr, s�r.rru- <br /> L�c.. s��� zSze. _ '�3ia (�e�) �3- 53�s <br /> TENANTNAME ONT�CTFORPERMIT PHONE <br /> F�c�zo�-Q �'�'F�L�sTF�S£7-� <br /> iSI�r,T�.� % �rv.tt E u,.SC�u�� P-Rc�f�r�-sS �2�r�',zs.z55'3 <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> SC�J�e G�ft'[�,t� Isol � �� ST, SI��.IE `zs�-�5'23-z191 <br /> CONTR.LICENSE# <br /> SC�Aco-�C�E o8y t35 9 si33 <br /> USE OF BUILDING F_ ' ���i HEAT SOURCE CONTRACT PRICE OF W`O�RK <br /> I �� o�`� Eleclric �Gas_Other �70� ��. <br /> I <br /> i WORKDESCRIPTION �E���.� 1��^ �.�`c�T �L S�(cy��-��C}�, <br /> f(—�—�a�> <br /> �L1h7'�J�i�X-'�r—�S `�� ��/I rG(L-c-1�9'�-' S��i"5 . � '1 ��E�—'� <br /> l r< <-43�s c�c� A��. i (o-3C� S� <br /> PLUMBING MECHANICAL <br /> i N0. TYPE OF FI%TURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> . �Q Toilet _ fVC-air handling units � <br /> �� Bathtub _ Forced air syslems <br /> �_ Lavatory(wash 6asin) \ _ Gas piping <br /> � Shower \ Water heater <br /> �. Kitchen sink 8 disposal \_ Gas fireplace ,.'� <br /> � � Dishwasher �_ Gas range ,- <br /> i _ Clo�hes washe� \ Clolhes dryer <br /> Laundry tray = Range�l5ood <br /> i � Sink(servicelbar,'moplelc.) _ ��Exhaust fan <br /> �Backflow preventer _ I��t pump <br /> ��� � Utinal � "Unitheater <br /> �I � Drinlcing Fountain !� Bniler\ <br /> Floor orain _ Refngera� n <br /> � _ Grease tteP _ Woodstove <br /> �I _ Roof drains. _ Olher� <br /> Other , <br /> � CITY OF EVERETT LOCAL SALES TAX COOE IS�105 <br /> �� I hereby cerihfy that I have read and examined thi5 application and kno�v the same lo be true and correct. All pmvisions of laws and <br /> � ordinaces goveming ihis type of work will be complied with whether specified herein or noL The granling of a pertnit does not presume <br /> � to give aulhonty lo violate or cancel the provision of any other state ar local law regulating conslrudion or the pedortnance of <br /> �� construc on.Thai I am authonzed by the owner of this property to pertortn the work for which apptication is made and I comply with the <br /> �� Stat C ntractors Law 18.27 and�96200 WAC. <br /> • � 0 <br /> . ignature of OwnedContreIXor/Authonzetl Agent D e 1// <br /> ! � <br />