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PERMIT APPLICATION <br /> CITY OF EVEkETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAh 425-257-8857—www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS {C `,�_�1�,j PARCEL TAX I.D.# PERMIT# <br /> 15 v ��,��� A��" L���r-�' ,;�n '1 abo�- <br /> LEGAL LOT NO. BLOCK iRACT OR SUBUIVISION# <br /> D[SC. <br /> OWNER , ADDRESS CITY/ZIP PHONE <br /> h�;�/1 ��j���� <br /> TENANTNAME CONTACTFORPERMIT pHONE <br /> � � � • �{ 2$ 3`la-SIl2 <br /> .X�in�nt � i ��(r. e-MAII � �•�n�ner'I��CJmi(ito} � uT <br /> NTRA TOR ADDRESS ITYIZIP N <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Eleclric _Gas_Other <br /> WORK DESCRIPTION ,��,rn F!� Y� � I�CL�� i�nCl �����i,L <br /> PLUM8ING MECHAtvICAL <br /> NO. NPE OF FIXTURE OR IIEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C–air handling units <br /> 8alhtub Forced air systems I <br /> Lavalory(wash basin) � Gas piping <br /> Shower Waler heater <br /> Kitchen sink&disposal � Gas(ireplace S'-�J�._ <br /> Dishwasher Gasrange <br /> Clolhes washer Cbthes dryer <br /> Waler healer Range hood <br /> Sink(servicelbar/mop/etc.) Exhaust fan <br /> Back(low pre�enler _ Heat pump <br /> Urinal Unil healer <br /> Drinking fountain _ Boiler <br /> Floor drain Refrigeration <br /> � Greaselrap _ Woodstove <br /> Roof drains Olher_ <br /> Other <br /> CIN O�EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I heraby cerilify Ihat I have read and examined this applicalion and know the same lo be lrue and correct. All provisions el laws and <br /> ordinaces governing this lype of work will be complied with whether specified herein or noL The granling of a permil does nol presume <br /> � lo give aulhority to violate or cancel ihe provision of any other slate or local law regulating construclion or ihe performance of <br /> iconslruction.Thal I am authorized by Ihe owner ot this property to perionn the work for which applic2lion is made and I comply wilh the I <br /> Sta�e Conlraclors Law 18. RCW and 29d.200 WAC. � <br /> � ,�) <br /> � l . -, 1-i,L �.t �': , /J � <br /> I Signalure �,, wnedConlraclorl ulhonze Agent e�� <br /> -----�—.1--- - — ----- -- I <br />