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PERMIT APPLICATIUN <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 L., _ j _ O� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT il� <br /> 5 n <br /> � � 1�e� � .�r��- �;� '� �� bQo000 6 f ib5 J <br /> LEGA LOT NO. BL CK TRACT OR 1SUBDIVISION# � <br /> DESC. � UC.fi.1{CYlc' �•��������'� � <br /> OWNER P�DRESS CITY/ZIP PHONE <br /> � 5Uj ��L��a�Cvt� u.?�.� � (�1.2s)35� tiY�r/ <br /> �-Ir=„N,n t �n.���,� i i n 1`7�l�ir(tu( ��'�YT� <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> c <br /> ,�����..� �.���(�,vc'�'l �Ji�la�4 `e ����7 � �71J" J-09y� <br /> CONTRACTOR ADDRESS � CITYIZIP PHONE <br /> ��'-„Z�'�� <br /> `�ti11�C ' � <br /> CONTR.UCENSE J! I <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �Lllurc <'.;l C` .� ,{{ ���Q . C)O <br /> � ��- �I�� i�`� Eleclric�Gas�Other <br /> � t,l V� �� "� ---c�q IO1' lc) — <br /> WORKDESCRIPTION � � �(,.rYnCY1C–'�11 S�J1^u ��c�a'�uC�� <br /> � Qn��rvc'�ibn o� 2U x �U �- ' S� � ,/ ✓ <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel _ A/C–air handling units <br /> Bathtub Forced air systems <br /> Lavalory(wash basin) _ Gas pipiny <br /> Shower W ater healer <br /> Kitchen sink&disposal _ Gas(ireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryr�; <br /> Waler heater Range hood <br /> Sink(serviceNar/mop/elc.) _ Exhaust fan <br /> Backllew prevenler _ Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease irap _ Woodslove <br /> Roof drains Olher <br /> � _ Olher — <br /> CITY OF EVERETT LOCAL SAIES TAX CODE IS 3705 <br /> I hereby ceriti(y that I have read and eeamined this applicatio�and know ihe same lo be true and rorrect. All provisions ol laws and <br /> ordinaces c�oveming lhis lype o(work will be complied wilh whelher specified herein or not.The granting of 2 permit does nol presume <br /> to givo aulhoriry to violale or cancel�he provision o(any other state or local law regulating construclion or lhe per(ormance of <br /> consWction.Thal I am aulhorized by�he owner ot this property to pedorm the work for which application is made and I comply wilh lhe <br /> State Contractors Law 18.27 RCW and 296.200 WAC. / <br /> _ �' ��,J /�b��'� � � <br /> r7i �: �_ "-<-` -� <br /> Signaturo of OwnedConlracior/Aulhonzed Agent { Date �Z <br /> � <br />