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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 ��3 ,-O� <br /> SITEADDRESS PARCE�T /L4:# PERMIT# <br /> ' l � ����� v� �vr-2r rr C.� �S �7 7Z �J C� . 70/ � Z <br /> LEGA L TN . BLOCK TRACT� � <br /> DESC. � Z YJ /Y. �C,�� G7 YL� <br /> OWNER ADDRESS CITYIZIP PHONE <br /> N�I�a� � (�ry ;� , ��2 �7 �5 � ��,/ Si SWLS��Ii/liG✓C�y�O �✓A�Qc�7O�� �r25-22�- 55`Io <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> l�n�nn� P (3ovs�t� 42 >-22v-y�90 <br /> CONTRACTOR ADORESS CITYIZIP PHONE <br /> 7(3 C'c/�J�i c/c ft Ce� j 3� ry � .,-3.�� S T S u/ �-Yii//Vr,�/e2w' tt 2 ) - 2 Z o SS%c� <br /> CONTR.LICENSE M f R�,O� ,�C� ��S Nr' (,.�!� �J�a S�� <br /> �� 'i <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � ✓ Electric Gas Other <br /> S �NL•4: I'�����y 12LSiI)En� — — �Soo �'� <br /> WORK DESCRIPTION <br /> C'a� ��e��.� `l�-OS�F f�je>>ti���'a� i���� Coa,a[t �* c�, 5'poc�e <br /> ! c� )� �' (3cly (,..t:ai�oc,� t�t ,-Nv.i�� �CU:��' <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. NPE OF FIXTURE OR ITEM <br /> •� Toilcl A/C—air handling units <br /> Bathtub Forced air syslems <br /> �J_ Lavalory(wash basin) Gas piping <br /> � Shower Z Vvaler healer <br /> Kitchen sink 8 disposal Gas(ireplace <br /> Uishwasher Gas rango <br /> � Clolhes washcr � Clothes dryer <br /> Waler he�ter Range hood <br /> Sink(servicelbar/mop/elc.) � Exhaust fan <br /> Back(low prevenler Heat pump <br /> Urinal Unil healer <br /> Drinking Founlain _ Doiler <br /> Floor drain Refrigeralion <br /> Grease lrap Woodslove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y thal I have read and examined Ihis applicalion and know lhe same lo be lrue and correct. All provisions o(laws and <br /> ordinaces goveminc� lhis rype of work will be complied with whelher specified herein or not.The�ranting of a permit does not presume <br /> lo c�ive authority to viola�e or cancel lhe provi;ion ol any olher state or local law regulating consWction or the pertormance of <br /> conslruction.Thal I am aulhorized by Ihe own�r of this properly lo pedorm the work tor which 2pplicalion is made and I compiy wilh the <br /> Slale Contractors Law 7827 RCW and 29�.200 WAC. <br /> ///' <br /> l�N-a....�-✓T C�. O�. i� � <br /> Signalure ol Owner/ConUactor/Aulhorized AyeN Date � <br /> �L <br />