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( �ERMIT APPLICAT�ON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425•257-8810 - FAX 425-257-8857-evw�v.everettwa.org <br /> CS�`S`'�,�� APPLICATIONS ARE ACCEPTED FROM 8 AA1 70 4 PA1 _ <br /> ISITE ADDRESS PARCEL TAX I.D.# PE 11T# � <br /> `� 3r�' /}uc S� C,U �9.�3 -ca�� �c7�y -oG —' ; - ._,.� <br /> i LEGAL LOTNO. �LOCK /T/RACT /J /� /' �L / �J <br /> � Cc`,C.I (-C/li � �J O�f C.fi�/ �/'-�C C7�C'��C /u CO/7cE�C� <br /> � OL7NER ADDRESS C IZIP PHONG � <br /> �r�t.'icl l/��.^�rs /�.��C %..c. G�/ s/25 NFr�i7/.u^ c-Y L/ S%evr•�s ��2»l — <br /> TENANT NA1.1E CONTACT FOR PERh11T PHONE <br /> I <br /> F���Q Go�;�:.�� • �r �a= yz z: ,w-,-z/ <br /> , CONYRRCTOR �� �. ADDRESS CIN/ZIP � PNONE ` � <br /> Frrd%rv/�,� G/i�r/ts Cv�artr�, GZ! SriSM� r�illr'j G-�' Lk Stc��t�s , <br /> . CONTR.LICENSE# � �� •� �,• .• • . � � � <br /> Fi��/JG C-�U 5 J OQ •,, . � � � • . <br /> � USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK ! <br /> I �'�J ,X Elecldc _Gas_Other �/U� Q��/ _ <br /> 1 Y� � <br /> i VJORK DESCRIPTION <br /> ' � {,� :.r! l ,��or� - 2`f7 <br /> PLUMBING MECHANICAL <br /> N0. 1YPE OF FIXTURE OR ITEh1 NO. TYPE OF FIXTURE OR ITEh1 <br /> 3 Todet A/C–air hendlinc�units � <br /> � Z Oathtub Forcod air sy�stems <br /> ��. � Lavatory(wash basin) � Gas pipinc� <br /> Sltower � Waterheatcr <br /> � Kitchon sink&disposal / Gas fireplace <br /> i Dishwasher � Gas rangc <br /> � Clolhes washer .�_ Clolhes dryar <br /> � SNaterhoator �_ Rango hoed <br /> Sink(servicelbar/mopletc.) _,� Ezhaustfan <br /> Backflow provontor Heat pump <br /> Urinal Unil hoater <br /> , Drinking Founlain Boiler <br /> Floor drain Ro(rigeration <br /> Grease trap Woodslove <br /> � Rao(drains � / _ Othcr <br /> Olher <br /> — j, <br /> CITY OF EVERETT LOCAL SAIES TAX CO�E IS 7105 <br /> I here6y ceritify that I havo read and oxaminod this application and know tho samo lo bo irue and correcl. All provisions of lav,�s ani <br /> ordinaces governing this lypo of work will bo compliod wilh whotlier sp�cified herein or nol.Tho granling of a permit does not pres�ma <br /> Io give aulhority to violalo or cancel lho provision of any other slato or local law regulaling c�nstruclion or Uio performance o( <br /> construction. That I am authorized by lho o�vnor of lhis property lo perform tho v:ork for�vhich application is mado and I comply wlth u�,� <br /> Stale Contractors Law 18.27 RCIN and 296.200 WAC. <br /> Signalure of OwnedCantrectodAuthorized Agenl Dale � <br /> I� <br />