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PERMIT APPLICATION ,�� <br /> CITY OF EVERETT PERMIT SERVICES ��� <br /> 3��0 CEDP,R 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 3 ...JO� O{� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT� <br /> rjC.C� E�Si ►'wAG�,�[ J��yJ �<• Od�`tLG. c�W -cx� -Oc� CoSoq - <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. �,�1 �� <br /> OWNER ADDRESS CITY2IP PHONE <br /> L,a���n�0 ������ ; T�c- <br /> 1'0. �cx 8Y� c�� sTt��t� s ��zsy �f2� -3S� ��c7 <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> S-�c�� Cu ��s•S ��S -3SG 77 G � <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> LArcEGA..n I�Ui�„EC Z;a.. . <br /> ��•' �'� 8�(� <br /> CONTR.LICENSE# L,�}�E �-iilv01�3 �— 1��=-' STZWC�S 9�z5'S �IZ� �3CG ' ��G � <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �-�� _Eleclric �as_Olher <br /> WORK DESCRIPTION <br /> _��_ <br /> L�>r���'�c,iD,a e V= I�j`/ r�7 �� n <br /> l���� <br /> Lt�st.ci <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM17 NO. TYPE OF FIXTURE OR ITEM <br /> � Toilet A/C-airhandlinguni�s <br /> Z Bathlub � Forced air systems <br /> �_ Lavatory(wash basin) I Gas piping <br /> Shower _L Water heater <br /> i Kitchen sink& disposal 1 Gas fireplace <br /> � Dishwasher i Gas renc�c <br /> I Clothes washer I Clolhes dryer <br /> _ Laundry tray i Range hood <br /> Sink(service/barhnop/etc.) � Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinai Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Reirigeralion <br /> Grease lrap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 1105 <br /> I hereby cerilify that I have read and examined this application and know the same to be true and correcL All provisions of laws and <br /> ordinaces governing lhis lype of work will be com�lied wilh whether specified herein or nol The granting of a permit does nol presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> construction.That I am authorized by the owner of this pmperty to perform the work for which application is made and I comply with the <br /> Slate Conlractors Law 18.27 RCW and 296.200 WAC. <br /> (i- p\ <br /> ' ` lt�. ;' \ �i-5i'US <br /> Signature of OwnedConlraclodAuthorized�ent Dale <br /> � Y <br />