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F�RMIT APPLI�ATI�.N <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 - DEBIT& CREDIT C�",RDS ARE NOT ACCEPTED <br /> SI i E ADDP.ESS � Z PARCEL TAX I.D.# P MIT# <br /> ��Z. '�f �j2� I'+�e..� �n.�. �.5� � O O O t� . � �� <br /> LEGAL LOTNO. BLOCK TRACT / /� � �� � \ <br /> DESC. �� O 'G ►7 '(�4 N /d-CSC.�iTI�/�+" <br /> OWNER ADDRE55 ITYIZIP PHONE 9�dya <br /> 1 �a� i `5 ��:�c e ��e . ' Z�~3� �-� �`' A�eS � #Z�/ I'Yi�c�15I .,� <br /> TENANT NAME CONTACT FOR PERMIT PHONE Z d G ' <br /> C %T• �'r //�jlne , '.17e�o�c� h �NLJ.�erm;T , L, <br /> CONTRACTOR �- ADDRESS CITYIZIP PHONE <br /> ! � �. �. �7 <br /> CONTR.LICENSE# �A�C.��"C(JCC- �-- ��IG�'�� �YJ 5� ' <br /> USE OF BUILDING �X��,� �J H�A SOURCE CONTR,4CT PRICE OF WORK <br /> �es i� SJ�t�G. 6 —Eleclric _Gas_Other � �"�� ��a <br /> WORK DESCRIPTION `� <br /> �� I'►'�O c� �i�- � X � STI fJ� S Jb �-� <br /> o n�.,� �c; c�.Q. T, .Z. / .�. <br /> PLiJMBING MECHANICAL <br /> NO. TYPE OF FIX7URE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling unils <br /> Bathlub Forced air sys!ems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water healer <br /> Kilchen sink&disposal � Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundn,�Iray Range hood <br /> Sink(service/barlmopletr:.) Exhaust fan <br /> Backllow prevenler Heal pump <br /> Urinal Unil heater <br /> Drinking Founlain Boiter <br /> Floor drain Refrigeralion <br /> _ Grease trap _ Woodstove <br /> Roof drains Other <br /> Other <br /> CITY GF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> I hereby ceritify thal 1 have read and examined lliis application and know ihe same to be true and correcl. All provisions of laws and <br /> ordinaces governing this type of coork will be co;rpiied with whether specified herein or nol.The gr2nting of a permit does nol presume <br /> lo give aulhority lo violale or cance� Ihe provision of any other stale or local law regulating consiruction or lhe performance of <br /> cons�niclion.T!ial I am aulhorized by the owner of this proparty to perform the work for which application is made and I comply with the <br /> Stale�^.onlractors Law 18.27 RCW d 296200 WAC. <br /> ' � � � Y u <br /> Signatu wnedContra orlAulhon edAgenl Oa!e �Z <br /> i — <br />