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; PERMIT APPLICATION <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 ACCEP7ED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TA%I.D.# PERMIT# <br /> c g I R�e �°FEuF 3 / — � <br /> LEGAL LOTNO. BIOCK TRACT <br /> i oEs�. �o � � 3gl 0-00 Or V , p � �- <br /> OWNER ADDRESS CITY2IP PHONE <br /> � !-}(�-2l� � C,�QO�.S I 9 I °� R U�c�E t��,R 9 �"� I �+�- 3 3 5' - 3 IS Z <br /> I TENANTNAME CONTACTFORPERMIT PHONE <br /> � S A-r�� E <br /> CONTRACTOR ADORESS CITY2IP PHONE <br /> N� 6nR�.cJ 5��� � 9 o i� c� �s� �,� N� 4 a�-S�K-- �i l � <br /> CONTR.LICENStHI{���v�� n9p�� ^ QL �� 0 ��,3 I <br /> � �T I <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> C F R _Electric �Gas_Other (1 l�� � <br /> J <br /> WORK DESCRIPTION <br /> .LNS�'�L F� 'V'14S Fi.110.N��f-,� (.�JL��-I ��UG�.S 1}�1Id <br /> ✓� vJ (�c"'rJL �i'��i''F—!Z I <br /> PLUMBING MECHANICAL � <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet NC-air handling units <br /> Bathtub .,_ Forced air systems <br /> Lavatory(wash basin) 1- Gas piping <br /> � Shower _�_ 1Nater hea�er <br /> I _ _ Kitchen sink&disposal _ Gas(ireplace <br /> � Dishwasher _ Gas range <br /> �� Clothes washer _ Clothes dryer <br /> � Laundry tray _ Range hood <br /> Sink(servicelbar/moplelc.) _ Exhaust fan <br /> Backflow preeenler _ Heat pump <br /> �� Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> , Floor drain _ Refrigera�ion I <br /> '� Grease irap _ Woodstove <br /> � Roof drains Olher <br /> Olher_ ___ — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> �i I hereby ceritify that I have read and examined this applicalion and know the same to be lrue and correcL All provisions of laws and <br /> � ordinaces governing this type of work will be complied with whether specifed herein or not The c•anting o(a permit does not presume <br /> ' to give aulhoriry to violate or cancel the provision o�any other slate or local law regulaling construction or the performance of <br /> ' construction.That I am authorized by the owner of ihis property to pertorm the work for�vhich application is made and I comply with the <br /> � Stat Contractors Law 1827 RCW acd 296200 WAC. <br /> I ��, ( � '3U QS <br /> �, Si�}n ure o(OwnedConlractorlAuthorized Agent Dat <br /> I <br /> � � <br />