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PERMIT APPLICATiON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, �NA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE A�CEPTED FROM 8 AM TO 4 PM <br /> SITEADDRESS !(�IS RUCKEFE�{,cf A�• PARCELTAXI.D.# PERMITp <br /> �RF wn �istoi C��SoI -Oli <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION p <br /> DESC. <br /> OWNER ADORESS �G4��'1 155ih 5{ SE ��TM�Z�P PHONE <br /> ���I�erm� ��I�ver�� M�iJrc[- c�q �Z� 350-1441 <br /> �1 X i�2 <br /> TENANTNAME -�U��,rn ^nn J� CONTACTFORP��2MIT PHONpyzs 3� �yy� <br /> ���-� i���,� ;u� iermo T�la�era <br /> E•MAIL _. _ , _ <br /> CONTRACTOR AUORESS I IIP P E <br /> CONTR.LICENSEp 11V��"� ��ty� <br /> USE OF BUILDING H�AT SOURCE CONTRACT PRICE OF WORK <br /> �Electric _Gas_Olher � 3� Sa� <br /> WORK DESCRIPTION � f L 1 1� <br /> N�,, ,���YN�Ivq �iXl��� c7�nc� 5hee�i� (JCY� -�or �9d��1(GO✓Yl <br /> � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> I Toilel .vC-air handling units <br /> Balhtub Forced air systems <br /> I Lava�ory(wash basin) _ Gas piping <br /> I Shower Water heater <br /> Kitchen sink&dis�osal Gas fireplace <br /> Dishwasher Gasrange <br /> Clolhes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(serviceNar/mop/elc.) _ Exhaust fan <br /> Back(low preventer _ Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains Uther_ <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAJ(CODE IS 3105 <br /> I hereby cerilify thal I have read and examined lhis 2pplication and know lhe same lo be true and correcL All provisions of laws and <br /> ordinaces goveming this type o(�vork will be complied�vith whether speciticd herein or noL The granting o(a permil does not presume <br /> lo give authority to violale or cancel the provision of any other stale or local law regulating consWction or the performance o( <br /> construction.That I am authorized by th .Awner of this property lo perform the werk fur which application is made and I comply with Ihe <br /> State Conlractors Law 18.27 RCW 6.200 WAC. <br /> � _ , �� � O <br /> SignaWre o�OwnedContrectod u horized Agenl D te <br /> `�Z <br />