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PEr2MIT APPLICATIO��f <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8357—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE VOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D. # PE IT# � <br /> /b�cn r�(er��l� �`e�,� j-uilt�.,a�v G'Zl <br /> 7 'l3� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE ` <br /> (,ti�ccslv��s�� ���ii��> LDO �,a�✓ri1�f y ,T�rtif, fu��c L�2o �'�i,,��° j6'/a/ Cl��- S3c�S <br /> TENANT NAME CONTACT F R PERM�IT^ PHONE <br /> �ccN,�e-L I S�at�z l�u.rht�� �jzc� zGo 30� o <br /> CONTRAGTOR ��� � (�r��m'ccn6i'� ADDRESS CITY2IP PHONE <br /> �87 s C"�uf U;/// /1��r ,�2�,/�:y 9B�S2 <br /> CONTR.LICENSE# y�,_ <br /> C �(o:G-5%��� <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electnc Gas Other �jb _ <br /> �/ <br /> WORK DESCRIPTION �r�,���` )L� nr �a ��C� r���v�y �,�.1�,` ��,��/yl� <br /> r� � <br /> PLUMBING MECH� NICAL <br /> NO. TYpE OF FIXTURE OR ITEM NO, TYPE OF FIXTI:RE OR ITEM <br /> _ Toilet A!C—air handling unils <br /> _ Bathtub Forcedairsystems <br /> _ Lavatory (wash basin) Gas piping <br /> Shower Waler heater <br /> Kitchen sink&disposal Gas fireplace <br /> _ Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> , _ Laundry t2y Range hood <br /> Sink (service/bar/mop/etc.) Exhaust fan <br /> _ Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> _ Floordrain Refrigeration <br /> Grease trep UJoodstove <br /> Roof drains Other <br /> Other — <br /> � — — — <br /> i <br /> '. CITY OF EVERETT LGCAL SALES TAX CODE IS 3105 I <br /> � I hereby ceritify that I have read and examined this application and �now the same to be true and correcL All orovisions of laws and <br /> ordinaces governing this type of work�.vill be complied with�vh�;iier speci(ied herein or not. The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating conswction or the per(ormance of <br /> construction.That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> State Contractors Law 1827 RCW and 296.200 WAC. <br /> '�!>, � E,,, .. G <br /> �J�� ' /a <br /> SignalureTwnenCon tor/ uthonzed Agent Date , <br /> I <br />