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i <br /> �CRMIT laPPL.ICATIUN <br /> CITY OF EVERETT PERMIT �ERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857-www.E�verettwa.org <br /> APPLICATIONS ARE ACCEP7ED FROM 8 AM TO4 PM ��J '7D� -�� <br /> SITE ADDRESS PARCEL TAX I.D.Il PERMIT# J <br /> i�z z�',� �, � � , �- oos �_5 cnc�oo n s � oa � o,r 3 <br /> LEGA LOTNO. BLOCK TRA <br /> oEs�. � zo�-�_ va 3 - vC� <br /> OWNER A��RESS CITY2IP PHONE nQ OG� <br /> %�7 O <br /> � - . - ,� �� � , lc7� �C V1 31o�D- <br /> TENANT NAME CONTACT FOR PERh11T PHONE <br /> �YT— ��oOIL T�-2,3Z."y'�t�c.� <br /> CONTRACTOR � . A� RE55 � CITY2IP PHONE • ' � <br /> Cc�•-,aw�nl (..+:t'v+� ��a•�ry L.�� �;F). b�x 13b7� l�i�lLcJ4:�J[. tJW yc`�`—�Z <br /> CONTR.LICENSt# • � <br /> (.o„liC-►1olI0�✓�' . �3�c,�-l�S-b3&3 <br /> USE OF BUILDING ' � HEAT SOURCE CONTRACT PRICE OF WORK <br /> v � 2 _Electric �Gas_Olher `'1��� Q� XY <br /> a �i <br /> WORK DESCRIPTION � <br /> 1-1� �'' .�j� .Z <br /> /uc�a.� Cv^aC�t�2ac,i�a., <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF fIXTURE OR ITEM N0. NPE OF FIXTURE OR ITEM <br /> �� Toilel A/C—air handling units <br /> r �athtub ,� Forced air sysloms <br /> � L��atory(wash basin) � Gas piping <br /> � Shcwer � Water heator <br /> _(__ Kilchen sink 8 disposal Gas fireplace <br /> � Dishwasher Gas ranc�o <br /> � Clolhes washer Clothes dryer <br /> / Water healer Range hood <br /> � Sink(service/bar/mop/etc.) Exhausl fan <br /> Back(lovr preventer Heat pump <br /> Urinal Unit heacer <br /> Drinking Founlain Boilor <br /> Floor drain Re(rigeralion <br /> Grease lrap Woodstove <br /> � Roof drains _ Other <br /> ,_ Olher _ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby ceritify thal I have read and examined lhis application and know the same to bo true and correcL All provisions of laws and <br /> ordinaces governing this type of work will be cumplied wilh whether specified herein or noL Tho granting ot a permit does not presume <br /> to give aulhoriry to vinlate or cancel Ihe provisiai oi any other state or local law regulaGnc�conslruclion or lhe pedormance of <br /> construction.That I am aulho ' d by lho ownar of Ihis property to periorm lhe work for which applicalion is madQ and I comply with the <br /> State Contraclors Law 18 RCW and 296200 WAC. �!�3 <br /> — � �'-Z�4�� � �� X 7 <br /> SignaWrc� � ner nlraclor/Aulhorized Agent Date <br /> �C�a�r� 'I <br />