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PtRMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> ;� 3200 CEDAR STREET, f=VERETT, WA 98201 <br /> 425-257-8810-- FAX 425-257•8857—www.everettwa.org <br /> APPLICATIOIVS ARE ACCEFTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARC:EL TAX I.O.# PERMIT# <br /> � ^. _ ��L�� _ G���� �y,� no�l� MGYnD�'G(3 <br /> LEGAL LOTNO. BLOCK 7RACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> Ev�'� <br /> ii � _i l��wiiT >5/N �ocKEFcu�n� Ai� �sraa ► �fa5 ;5`_ �4�5' <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> h/-'('� I�I`t'lL'LII7� �-{Z,�77J'���.�Y <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> �q^r �-n�:i E d'�m��- H i C ILI�I�! /s'� fEt�. �i/ �%�N`��� � c /�,U' ! <br /> CONTR.LICENSE ti LI LS'�• � ��" / <br /> l�,4Y n��- �'N �'�/�!C'/vl ��7J.�7 <br /> USE OF BUIL�7ING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Electric y�t;as_Other �t J�5���, C�c� <br /> WORK DESCRIPTION <br /> kEP��fi�E �,cisn,J�,- ( f}s %u�c,ii�4-�E G�/i�Tt-F �c?�v CisJ-5 <br /> � r�/-'-�+/rICC <br /> F'LUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NJ. TYPE OF FIXTURE OR ITEM <br /> _ Toilet A/C—air handling unils <br /> Bathtub 3__ Forced air syslems <br /> Lavatory (wash basin) Gas pipiny <br /> Shower Water heater <br /> Kilchen sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br />�� Sink(service/bar/mop/etc.) Exhausl(an <br /> Backflow preventer Fleal pump <br /> Urinal Unil heater <br /> Drinkinc� Fountain Etoiler <br /> Floor drain Fefrigeralion <br /> Grease Vap N'oodslove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE 7S 3105 <br /> I hereby ceriti(y that I have read and examined Ihis application and know the same to be true and correcL All provisions of laws and <br /> ordinaces governin�this lype ot work will be complied with whelher speci(ied herein or n�l.The granting of a permil does not presume <br /> to give authoriry lo violate or cance�Ihe provision of any other slate or local law regulatinp conslruction or lhe pedormance of <br /> construction.Thal I am authorized by Ihe owner of Ihis property lo perform the work for which application is made and I comply with the <br /> � Slatc Cenlractors Law 18.27 RCW and 296.200 WAC. <br /> ��L �✓��-Lc�� b"- 5` �"'G <br /> S�natur f OwnedContraclorlA honze Agenl Date <br /> , <br />