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PERiV�IT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEqAR STREET, EVERETT, VJA 982�1 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE.4CCEPTED FROM 8 AM TO 4 PM 3 --�D—Of�/ <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# � <br /> �C.•C• t.JA-5`r ��l�t�'�2i,i� tlldti� AZ. C�G.�9�r�a - U�,O � UC;�� -�= CG'S G -V <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. �� G <br /> OWNER ADDRESS CITYIZIP �. PHONE <br /> �E' <br /> L}'rl�tL�.9�?/,� �;L�i?9L-� 7,rc - /�o, i°J,-'Jc c�i(� �-k - STe�'e�af Wrr c/25-5'S(: '77C7 <br /> TENANTNAME I CONTACTFOR PERMIT PHONE <br /> S�LV�_ w,.�,tn'�S `-ILC �"'SG -77G y <br /> CONTRACTOR AODRESS CITYIZIP PHONE <br /> (..A kLl.+ti/�Q ��k^�) '���� . ]. c Fj:�k �G'f �i <br /> CONTR.LICENSE p t�,� K�� F� � v� r 3� Lk, � i5 y ��f. 77G <br /> S-c�,��.r rb` 3Sc:- <br /> USE OF BUILDING — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ��-�� Eleclric ' Gas_Other <br /> WORK DESCRIPTION <br /> L,�,�sT�'� �, ,�,� o�= ��5 y r� SF2 <br /> ��� <br /> PLUMBING MECHAKICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> ,� Toilel AIC-air handling unils <br /> Z Bathlub 1 Forced air systems <br /> � Lavatory(�vash basin) `+' ! Gas pipinc� <br /> Shower � Water healer <br /> 1 Kitchen sink 8 disposal � Gas firep�ace <br /> i Dishwasher i Gas range <br /> i Clothes washer I Clolhes dryer <br /> _ Laundry tray Range hood <br /> Sink(service/bar/mopletc.) � Exhausl fan <br /> Back(low preventer _ Heat pump <br /> Urinal Unit healer <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease trap _ Woodstove <br /> Roof drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> i I hereby ceritify lhat 1 have read and exam�ned lhis application and know the same lo be We and correcL All provisions of laws and <br /> ordinaces c�overning this lype of work will be complied wilh whether specified herein or nol.The granting of a permil does nol presume <br /> to c�ive aulhority to violate or cancel lhe provision of any other state or local law regulaliny consWction or the pedormance of <br /> construclion.That I am aulhorized by lho owner o(this property lo per(orm the work for which applicalion is made and I comply with lhe <br /> Slale Contractors Law 18.27 RCW and 296.200 WAC. <br /> ` `- �� � -�i-U � <br /> SignaWre of OwnedContractorlAuthonzed A nt Date I <br /> � <br />