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i <br /> PERMIT APPLICATION � -� ��6 <br /> CITY OF EVERETT PERMIT SERVICES � ���� -0/ <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org � <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM /Ll/�u� � <br /> SITE ADDRESS PARCEL TAX I.D.# P �MIT# <br /> Sc�.c.. �,.��=� ;��r,�., . U;�� ;c ��-C- cx�o -cz,�� -�� 5 '-�3 <br /> LEGAL LOTNO. BLOCK /TRACT <br /> DESC. � d C� ;�� � � <br /> OWNER A DRE S CITY/ZIP4E�Se PHONE <br /> LriLcC.A,J�� �„i,� -�nC �U• Bc,X 64�" Le-- S'rE��C�S , lNP �-�' <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> 5-r�-vt �u n,.�-S ,S qZs 3sC �� c 7 <br /> CONTRACTOR (� ADORESS CITY/ZIP PHONE <br /> �l'L'4'..1�7 �-1�ln�c� �LAc- � <br /> l'••� �5��� �'%V 8 <br /> CONTR.LICENSE# �� ,L F{ � � L Le- ��r�(.L��S �� 2 " � <br /> � � J `�$ 5�' �! a • sG �7G � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��-�` _Electric �as_Olher /�����" <br /> WORK DESCRIPTION <br /> LG��S ��!�c 7�uv. p �� t�, j`r 4J S`c`r�- ��'� <br /> �,Ci <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> .+' Toilet�✓ A/C-air handling units <br /> z Balhlub ✓ � Forced air syslems ✓ <br /> � Lavatory(wash basin) � � � Gas piping <br /> Shower � Waler heater <br /> �_ Kilchen sink&disposal � �_ Gas fireplace <br /> 1_ Dishwashcr ✓ � Gas range <br /> i Clothes washer � C�olhes dryer <br /> Laundry trey � Range hood <br /> Sink(service/badmop/elc.) � Exhaust fan <br /> Backllow prevenler Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease Irap Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify lhat I have read and examined this application and knoH�the same lo be true and correcl. All provisions of laws and <br /> ordinaces governing Ihis lype of work will be complied wilh whelher specified herein or nol.The granling oi a permil does nol presume <br /> lo give authoriry lo violale or cancel the provision of any olher stale or local law regulating conslruction or the performance of <br /> conslruction.Thal I am aulhorized by the owner of this property to perform the work tor which application is made and I comply with the <br /> Slale Conlreclors Law 18.27 RCW and 296.200 WAC. <br /> � �+`..��� �..ji -OS <br /> SignaWre of OwnedConlractodAuthonzed Agenl Dato <br /> `�E ut�2� <br />