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PERMIT APPLICATIOIy�D [C�r����� �� <br /> CITY OF EVERETT PERMIT SERVI S <br /> 3?00 CEDAR STREEI', EVERETT, WA 982p1 j q Z�O� �D <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org ' <br /> .... <br /> APPL.ICATIONS ARE ACCEPTED FROM 8 AM TO 4_RN�;�-,.� „,F.EVERETT <br /> c. ,� . , <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT p <br /> ra?��l ��'iaac�z �� 1�5zo3 �� o� � oo�oc� <br /> LEGAL LOTNO. BLOCK TAACTORSUBDIVISIONp <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> �'Pl� ✓��c(i.u�{s (�e��l �1'►�-Ior�f G� �l.�t �fY'v3 9�� - �j3 <br /> TENANTNAM I CONTACTFORPERMIT � PHONE � G <br /> ���� -�CD /7S-�S�£s'L{ <br /> % � n���ltjn� �,(/.(h5�`� e-r�aJ7o7�"Wc�Le��j��tci� yu�IG (�r{� <br /> CONTRACTlO , �I � %_ App�EgS CI IP PH <br /> �U�iS✓1�M1�4-�7� �Ili,�C�' �Al-e,-� ��Jo �Z,d��� J�-� ��- �av - <br /> CONTR.LICENSE p%,� /L�N L���L O� r i � <br /> w� /?�z/Le��.� �,�1a %BvuS 17g-`658� <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric �Gas Other ���-lj� "- <br /> WORK DESCRIPTION � � <br /> �`��a��e Lt'U-f � � -l'�� I,I.,G+�-r; ��;�,�LP_p . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTUpE OR I'fEM NO. TYPE OF FlXTURE OR ITEM <br /> _ Toile� A/C-air handling units <br /> _ Ba1hWb Forced air systems <br /> _ Lavatory(wash basin) Gas i in <br /> PP 9 <br /> _ Shower Waterheater <br /> _ Kilchen sink&disposal Gas lireplace <br /> _ Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> � Water heater Range hood <br /> _ Sink(service/badmop/etc.) Exhaust fan <br /> _ Backllow preventer Neat pump <br /> Urinai Uni�healer <br /> Drinking Fountain Boiler <br /> _ Fioor drain Aefrigcration <br /> _ Greasc trap Woodslove <br /> Rool drains Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritity Ihat I have read and ezamined this application and know the same to be true and correct. All provisions of laws and <br /> oidinaces goveming this rype nf work will 6��complicd with whether specificd herein or not.The granting of a permit does not presume <br /> lo give authority to viotate or cancel Ihe provision ol any olher state or local law regulating consWction or the peAortnance of <br /> consiruction.That I am aulhorized by�he o�vner of this propetly to perform�he work lor which application is mado and I compiy with the <br /> State Conirac�ors Law 1827 RCW and 296200 WAC. <br /> C�,,,���).A>��:,� �\-\`6- 0`b <br /> Signalureo wnedCon�ractoI[lHuthorized �gent` �7 DatQ <br /> \ � <br />