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P�RMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 C[DAR 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 ��G��-,`�Z � <br /> SITE ADDR.ESS I3�� � PARCEL T I.D.# I PERMIT# <br /> jn�� O l� G 5��-p � <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRE S CITYIZIP PH E <br /> t�o.rt�.�r�'�.cc-r 13� �l�� C�z�l -�}0�3 <br /> —.��'��C^—�'�' `T"`� �.�R�'i'. 1.� �'j.fjzE� ty(�clr�� <br /> TENANT NAME CONTACT FOR PER T pHONE <br /> ��'� AS ��� ^ n ._ � <br /> /.�F3c��.c Y/i'`�./`��_ �� � � <br /> CONTRACTOR ---� ,)�'�'-{�' �(�+�4DDRESS� Q � CITY2IP PRONE �Z� <br /> CONTR.LICENSE# ` � !� � �1�� `^ �`�'` w'r�'�� �`�(7 <br /> WAi--v-��coS4�.E1 ��t-�lt�4 <br /> - .-� <br /> USE OF BUILDING NEAT SOURCE CONTRACT PRICE O�WORK <br /> c�',�`�,n.�N ���� _[Icctric _Gas`Other �2,0�0(� <br /> WORKDESCRIPTION D���J pn � <br /> q F�ve/.a-(-ra� • v��i��rre � 6e wr�re�1, <br /> i�( s�h��E: �d��� g��,��. �1 a�^�,e. <br /> PLU BING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling unils <br /> Galhlub Forced ar systems <br /> Lavatory(�,3sh basin) Gas piping <br /> Shower Water heater <br /> Kilchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer C;uthes dryer <br /> Laundry tray Rangc liood <br /> Sink(service/badmop/elc.) [xhaust fan <br /> �aakflo�v prevenler Heal pump <br /> Urinal Unit heater <br /> Drinkinc� Founlain Boiler <br /> Floor drain Retrigeration <br /> Grease trap Woadslove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODC IS 3105 <br /> I hereby ceritify thal I have road and examined thi,application and 4;now the same lo be Iruo and correct. All provisiuns of laws and <br /> ordinaces goveming this rype of work will be complied wilh whether specified herein or nol The granting of a permil does not presume <br /> to give aulhoriry to violale or cancel lhe provision o(any olher stale or�ocal law regulating construction or the performance ot <br /> consiruclion.Thal I am aulhorized by the owner of lhis property lo perform the work(or�shich applicalion is made and 1 comply with lhe <br /> Slale Con ctors Law 1827 RCW and 29G.200 WAC. <br /> Signalure o( wne onUactodA horized Agenl $ D' ate ��(�� -V�s <br />