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P�.r�MIT APPLICATIC _� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADGRE S PARCEL TAX I.D.# PF�2MIT# <br /> �-113 oeLcE %C�e-� � ��« - �`1c�S 7cm�ol �G� / � J���, <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER - ADDRESS CITY2IP PHONE � � <br /> �' �.I , �� L , l�-r'� u� r i �� � ��ccJ�.���:�� ,�ti�u � �,�.��, �c��-r -( <br /> TENANT NAME CONTACT FOR PE 111' PHONE <br /> E•MAIL <br /> CONTRACTOR � ' � — '�� �� D�RESS ' �- •CITW�IP P O E <br /> oF �tirST� �.ti� w!�ts(-(i.�G`�'a1 t �ILrC� 1,0, Dl�� S� o,� ���D�- 33G�--�S .�- <br /> CONTR.LICENSE k �- � � 1 �Y�lT, ����'� "�� C� �"�7� <br /> T I � �o PT . I. <br /> USE OF BUILDING � HEAT SOURCE CONTRACT PRICE OF WORK <br /> '( ��� ���'���� _[lectric ✓ Gas_Olher <br /> \ -( <br /> WORK DESCRIPTIVN I 11.5-F�C, QQ���� D �([�- � ( �Q�lt � (����t I <br /> 1 w � <br /> 1 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEfA <br /> Toilel A/C-air handlinq unils <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) � Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposai Gas fireplace <br /> Dishwasher Gas range <br /> Cblhes washer Clo�hes dryer <br /> N�ater heater Range hood <br /> Sink(service/bsr/mop/etc.) Exhaust fan <br /> BackOow prevunter Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain . Boiler <br /> Floor drain Refrigeration <br /> �3�ease Uap Woodstove <br /> Root drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I heieby ceriti(y Ihat I have read and examined this application and hnow lhe same to be true and correcl. All provisions of laws and <br /> ordinaces goveming lhis type of work�vill be complied wilh whether specified herein or not.The grenting o(a permit does not presume <br /> to give authonty to violate or cancel the provision of an��other state or local la�v regulatir.g conslruclion or lhe per(ormance of <br /> construclion.Thai I am autho ed b�the owner of this property lo perform lhe work for which applicalion is made and I comply wilh the <br /> Slal -QoqUa¢lors law 18.27 CW an 29u�ACt � <br /> --� %I � <br /> t �� : � ". t � � <br /> Sig atureb(OwnervCon ract riAuthorized Agent a e <br />