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P�RMIT APPLICATIG�I <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAF; STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857—www.everettwa.org �� J� ����! Z <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �{p5 r�-p3S <br /> SITE ADDRESS I3I I �{�'� FARCEL TAX I.D.# PERMIT# <br /> q5 2��5� 1� 5os-orZ <br /> LEGAL LOTNO. BLOCK TRACT <br /> _DESC.�- <br /> �WNER ADDRESS CITY2IP PH E <br /> ��1 w�c�`E,� 19',b � T1c l -�4�3r3' <br /> �'�'i� �'�� .�-►�z. �r�r��r- L.Y� �'� �,�-rs�fGa�- <br /> TENANT NAME CONTACf FOR PE�t+R 1T PHONE <br /> ��'I� AS �`1�12 ��� �t�a� � �!(O("'g�� <br /> CONTRACTOR (x��, '�C.(F1(�{`'�ODRESS`O Q �y CITY2IP PHONE �� 2 <br /> t ���, /L,q ,�'•� �—lJl�7 <br /> CONTR. LICENSE N �'��� ������ <br /> Wbu�-�dSfk-9 ��t-c�,s�� <br /> USE OF BUILDING HEAT SOURCE � CONTRACT PRICE OF WORK <br /> ��I� ����� '� _Electric _Gas_Othr,r � 2��� <br /> WORK DESCRIPTION �e��� � � ,� <br /> q F�v,�la-Fc�r, � v����erre� be wr�rrs�. <br /> � �5�1,�(e F��,�� �e��r,e I� a�v-���, <br /> PLU BING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilcl A/C—air handling wiits <br /> Dathtub Forced air syslems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower W aler heater <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwashcr Gas range <br /> Clothes washer Clothes dryer <br /> Laundry lray _ Range hood <br /> Sink(servic�/badmop/elc.) _ Exhaust fan <br /> Back(Iow preventer — H����P��»P <br /> Urin21 Unil healer <br /> Drinking Founlain _ Boilcr <br /> Floor drain Refrigeration <br /> Grease Irap _ Woodctave <br /> Roof drains OUier <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby ceritify Ihat I have road and examined fhis applicalion and know the same to be true and correct All provisions ot laws and <br /> ordinaces governing lhis type of work�vill be complied wilh whether speci(ied herein or not.The granting of a permil does not presume <br /> to give aulhorily lo violate or cancel ihe provision of any olher state or I�cal law regulalinc�construction or the performance of <br /> construction.Thal I am authorized by Ihe owner of this properly lo perfonn Ihe work(or which application is made and I comply with the <br /> Slate Coi aclors Law 18.27 RCW and 29G.200 WAC. <br /> � � , D <br /> ��IG�A��d <br /> Signalure o O r/Contractor/ uthorized Agenl Dale <br />