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PtRMIT APPLICATION <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 <br /> SITE ADDRESS PARCEL TAIC I.D.# PERMI7# <br /> � <br /> [. � � v�C �1c(' � l: Gr. Oc�y3o�,01 �m.�-'Y �u-to �-o16 <br /> LEGA LOT NO. ,2 BLOCK TRACT <br /> DESC. �J (�j 1Nf•2c,{-• /�+ t,' � <br /> OWNER l AD�RE55 CITY2IP PHQNE '/)S- <br /> 7 <br /> (/��C i< i !S �s l Ei� �`f l i �(���(' 'c S�, ����,��r r/� 1�,�0.�3 3�i�3D� <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> St��� � <br /> CONTRACTOR � y � �/�_il5f�i��+����ADDRESS CITY2IP PHONE �(�G <br /> G '\ /.� /, � �- �J 7-c�I,�c <br /> CONTR.UCENSE Iz J�S C //�� l� /�•z ��' K� K'� �f' <br /> �('�eTv ��ri Pfi 0 �r�s� <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �'r�� � _Electric _Gas_Olher � �i Qq0 <br /> 1 i�- -c'r�c'- C. <br /> WORK DE��Tw10`� � �� � <br /> �9 t> �� 7Z r5 7 �E ri � .f� <br /> PLUMBING MECHANI AL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet A/C-air handling units <br /> 6alhlub Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Shower Water heater <br /> �- Kilchen sink 8 disposal Gas fireplace <br /> Dishwashcr Gasrange <br /> �' Clolhes washcr Cblhes dryer <br /> Waten c�aler Range hood <br /> _ Sink(service/bar/mop/etc.) L_ Exhaust fan <br /> Backflow prevenlcr Heat pump <br /> Urinal Unil hea�er <br /> _ Drinking Fountsin Boiler <br /> Floor drain Rofrigeralion <br /> Grcase trap Woodslove <br /> Rool drains Olher <br /> Other <br /> CI1Y OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby ceritity that I have read and ezamined Ihis applicalion and know the same to be lrue and coRecL All provisions of laws and <br /> ordinaces goveming lhis lype of work will be complied with whether specified herein or noL The gra��ting of a permil does nol presume <br /> to give authority lo violale or cancel Ih�provision of any other state or local law regulaling construction or tho pedormance of <br /> construclion.That I am aulhorized by the owner of this property to pedorm the work tor which applicalion is made and I comply wilh the <br /> Stale Contractors L-w 18.27 RCW and 296.200 WAC. <br /> �� l <br /> �� ���o �, . ��z� p-� <br /> Signalure of ier/ ntracloqAulhonzed Agent Dat <br /> �/?_ <br />