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PtRMIT APPLIC.4TION <br /> CITY OF EVERETT PERM!' SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 9820'i <br /> 425-257-8810 - FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM S �S-v� <br /> SITE ADDRESS PARCEL TAX I.D.# 1 PER�T# _ JI� <br /> 0 3�' 3 - / sr�,-- S� �l ., " _ <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION ft <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> K[�/7 / O�/?? �!/��3 — /�vr— .�F -�G�G"/ /vZL�� `Il� Z�C� _�C'[) 7' <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> E•MAIL <br /> C TRACTOR ADDRESS �^ 21P � O E .z /` <br /> Fy�h,.��s' S? �J �'S�r�/, 1nC 3FC/ ,[✓G���'� G " t�g�� �Z7�'7`�` � <br /> CONTR.LICENSE# <br /> �y�9,�>s ��, Z�s �Z <br /> � ONTRACT PRICE OF WORK <br /> USE OF BUILDING HEAT SOURCE <br /> �` <br /> � � � ��GD— <br /> � �Eledric _Gas_Olher <br /> WORK DESCRIPTION <br /> �MJ�Ii 0���`isf ��l�C„l� <br /> PLUMBING MECNANICAL <br /> NO. TYPE OF FIXTURE OR ITEM11 NO. TYPE OF FIXTURE OR ITEM11 <br /> Toilcl '= A1C—air handlirg units �, <br /> Bathtub � Forced air syslems � <br /> Lavalory(wash basin) _ Gas piping ' <br /> Shower Waler healer <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gas ranc�e <br /> Clothes washer Clolhes dryer <br /> Waler healer Rang�hood <br />-- Sink (service/bar/moplelc.) Exhausl tan <br /> Back(low preventer Z Heat pwnp <br /> Urinal Unit heater <br /> Drinking Founlain _ Boiler <br /> Floor drain Re(ric�eralion <br /> Grease trap _ Wuodstove <br /> Rco(drains Other <br /> Other <br /> � <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 9105 <br /> I hereby ceritify that I have read and examined this applicalion and know lhe same lo be true and correct. All provisions of laws and <br /> ordinaces governin�this lype ot�vork will be complied�aith whether specified herein or noL The granling o(a permil does not presume <br /> tu give aulhority to violate or cancel the provision of any other slate or local law regulating construclion or lhe performance of <br /> consiruction.That I am authorized by lhe owner ot lhis property lo pedorm Ihe work for which application is made and I comply with the <br /> Slalc ConUac s Law 18.27 RCW and 296.200 WAC. <br /> � � ��� j_J�` ! <br /> � '�'��/' � <br /> Sigrh ure o wnedConlractorlAuthonzed Agenl Dale <br /> � - - - - --- <br /> 1 <br />