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PL�2MIT APPLICATIG�J ,,., ;. ;; <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everethva.org �� � /,DC�_�� <br /> 'r I <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBII'& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> r t � co M���ti S'i, Oc�13e� ZZ-6a 2.�+0o C� ��� `/ a- <br /> LEGA LOT NO. S� BLOCK TRACT _ .,� _ � <br /> DESC. �_a � <br /> OWNER c�us-r. 3�aa DV��AV�. �� LUE'�EiT IC.C�.'.7 O' IW"��'�3� <br /> I��t�ck P,g.os, <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �oEL HAPc� �1zS-2.��d-2�iZ�1 <br /> CONTRACTOR '-t1'��L1� ��,{)� ��/q"•-�, AODRESS;j��a b�� CITY2IP PHONE <br /> �`� �'e �ucr�r<< 1j2S�39� 7360 <br /> CONTR.LICENSE N �POS <br /> _ yc��c�S310 ��.vZ <br /> USE OF BUILDING I — HEP;f SOURCE I CONTRACT PRICE OF WORK <br /> S�" �- Eieciric �Gas Olher 1�d 1\ <br /> WORK DESCRIPTION <br /> Nc�.� s `�_ ���� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � ?oilet A/C—air handling units <br /> � Bathtub � Forced air systems <br /> � Lavatory (wash basin) ��` Gas piping <br /> Shower ,L Water heater <br /> I Kilchen sink 8 disposal Gas fireplace <br /> �, Dishwasher � Gas range <br /> �_ Clothes washer Clothos dryer <br /> _ Laundry tray Range hood <br /> Sink(service/badmop/etc.) Exhaust fan ;!" <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease lrap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS]105 <br /> � <br /> II hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> I to give aulhonty to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> construction.That I am authorizea by the owner ot ihis property to perform the work�or which application is made antl I ramply wilh the <br /> � Slat Contractdrs Law 1827 RCW a 296200 WAC. <br /> I ��.�� �``�' . �-�s��i� <br /> Sign ture OwnenContrec o uthonze gent Date r/ <br /> I � <br />