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P'�RMIT APPLICATI(��V <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org O�, S��_�� <br /> ( <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS � / �?j 3 PARCEL TAX I.D.p PERMIT p � ��/ <br /> 2f�l�S �� $��3L^L7d� SGO G f�s� „/ <br /> LEGA L� BLOCK TRACT <br /> DESC. � u � a��-3 a-c�V <br /> OWNE �- �� A DRESS CITY2IP PNONE <br /> �v_���e— �5� �•.�-'_C �20..� L�L lzlzt3 �t.�.i��...-.tt �>�..� <br /> Ec�c—�k c.�.w • `iS's2o�s <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �{ZS 3 -e��l , ,. . <br /> ' • L���L, ic��cl � �IZS-'9�Sv-�C�eb ; <br /> CONTR4CTOR �1�\T, �! ADDRESS CITY2IP PHONE <br /> lZ�zp� ���� 4e.:-� ����-� yc.S-3�S-z2,�1`1 <br /> CONTR.LICENSE# +� <br /> �r- � ' ��.; .—zUG � C.�-f�. '��: L�' -r L S ' 1 j��-��+�� <br /> USE OF BUILDING I — HEAT SOURGE I CONTRACT PRICE OF WORK <br /> o�j <br /> l �2 Eleciric SCGas Olher � SiC� <br /> WORK DESCRIPTION <br /> � S .�2 _ 2 �-s: �e..�-� �'1 c��� 2ca� 5�2�5 e <br /> PLUMBING MECNANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FI%NRE OR ITEM <br /> Toilet - A/C-airhandlingunits <br /> 7- Balhtub Z Forced air systems <br /> `3 Lavatory(wash basin) � Gas piping <br /> � Shower 1 Water heater <br /> � Kitchen sink&disposal � Gas fireplace <br /> �_ Dishwasher � Gas range <br /> � Clothes washer � Clothes dryer <br /> _ Laundry tray � Range hood <br /> _ Sink(service/badmop/etc.) � Exhaust fan <br /> _ Backflow preventer Heat pump <br /> Urinal Unil heater <br /> Drinking Fauntain Boiler <br /> _ Floordrain Refrigeralion <br /> Grease Irap Woodslove <br /> Roof drains Other <br /> Olher <br /> CIN OF EVERETf LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that 1 have read and examined this application and know the same to be lrue and correct. All provisions of laws and <br /> ordinaces governing this type ot work will be complied with whelher specified herein or not.The granting oi a permit dous not presume <br /> to c�ive aulhority lo violate or cancel the provision of any other sfale or local law regu�aling construction or lhe performance of <br /> wnsiruction.That I am aulhorized by the owner o(Ihis property to perform the work for which application is made and I comply with lhe <br /> Stale Conlractors Law 18.27 RCW and 296.200 WAC. <br /> � // � — 22—Lc�S <br /> Signalure of OwneqContra Authonzed Agent Date 1/ <br /> 2 <br />