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PrRMIT APPLICATIVN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR 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 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> �� 3L vc ' - z�� �� /�/2'// <br /> LEGAL LOTNO. BLOCK TRACT <br /> DFSC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> ���F1'�E'7 �� ��K�� /53 Z ��--x��-�� �v� �ZS. 3 oS3. 5333 <br /> TENANTNAME CONTACTfORPERMIT PHONE <br /> y��( <br /> T�-�"-��-� �-��-� �-�--� ��«� E��, �zs _��8 S-�3 <br /> CONTRACTOR AUDRESS CITY2IP PHO4E <br /> Y Zv ✓�'ln` <br /> CONTR.LICENSE P <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> �',�,ti,�� _Electric �s_Other <br /> WORK DESCRIP710N <br /> ��a�L�uc Z ,,,� C�,� �tii �"ri=`�2 f]^�v Nvo/C Ta �v�/�� <br /> dtit�T�-72 � ����.s� !s o�v vNe st�'vi�� �^���-� Tl��ti Two , <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel _ A/C—air handling unils <br /> �alhtub Forced air syslems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Water heater <br /> Kilchen sink 8 disposal _ Gas fircplace <br /> Dishwasher _ Gasrange <br /> Clothes washer _ Clolhes dryr,r <br /> Water heater _ Range hood <br /> Sink (servicelbarhnop/etc.) _ Exhaust fan <br /> 6acktlow prnventer _ Heat pump <br /> Urinal _ Unil heater <br /> Drinking Fountain _ Boilcr <br /> Floordrain _ Refrigeration <br /> Grease trap _ Woodslove <br /> Rooi drains _ Olher <br /> Other — <br /> CITY OF EVERETT IOCAL SALES TAX CODE IS 7105 <br /> I hereby ceriti(y thal I have read and examined this application and know the same to be We and correcl. All provisions o(laws and <br /> ordinaces governin�Ihis lype of work will be complied wilh whelher specified herein or noL The granting ot a permil does nol presume <br /> lo give aulhoriry lo viol2te or cancel Ihe provision of any other state or local law regulating construction or the performance of <br /> conslruction.Thal I am authorized by the owner of this property to per(orm the work(or which application is made and I comply with the <br /> Slale Contractor�s Law 1827 RCW and 296.200 WAC. <br /> �l1 ` l� /�.� lZ- � -�S <br /> SignaWYe wn rl �ctodAuthonzed Agent Date <br /> L_ — -- <br />