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F�RMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CE�AR STREET, EVERETf, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everetlwa.org <br /> APPUCATIONS ARE ACCEPTED FRI;M 8 AM TO 4 PM � � 3�G7�� <br /> � <br /> SITE ADDRESS PARCEL TAl(I.D.# PERMIT# <br /> �8�� v -���:� ,��.,«- �o��3.o�.;z.,. ��� /2 '005 <br /> LEGAL LOT N0. BLOCK TRACT OR SUBDIV:SION�! <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONEyL>�S'ji -E2f 3 <br /> �,J ��a'1.o5 ��.� tc�t�1T :���'7 N•���Y 1�� �vr=:�-T (.�� ��cb / <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> J�..n; ..15 c.ina:.( E�MAIL <br /> NT�R A� R 5 Y/ I �— <br /> CONTR.LICENSE p ��7 � / � <br /> ��"�''<'� /�1�9J - <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> i � _ �Eleclric Gas Olher t''j—�� <br /> '�;.�c..,,:. r,.t._ �y x�-v�s:�.:...r.� — — <br /> WORK DESCRIPTION �,..5..,:_sti.�. ��r-,c <br /> �L.��/K: /-aJr N..� J IJJ7 /�1...���;.,-S � � • <br /> n.c.. <br /> No Liv uc, SF�F1c: 7u r-t �c <br /> PLUMBING MECHANICAL <br /> NO. � TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilcl NC-air handlinc� units <br /> �ath;ib Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Watcr heater <br /> Kilchen sink&disposal Gas fireplace <br /> Dishwasher G2srange <br /> Clolhes washer Clolhes dryer <br /> Waten c�ater Rango hood <br /> Sink(service/bai/mop/etc.) Exhaust(an <br /> [3ackflow prevenler Heal pump <br /> � Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease lrap Woodstove <br /> Roo(dr2ins Olher <br /> Othr,r <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y lhal I have read and examined lhis applicalion and know ihe same lo be true and cormcl. All provisions o1 laws and <br /> ordinaces governing this lyp�of work will be complied wilh whelher specified herein or noL The yranting of a permit does nol presume <br /> to give aulhonty lo viulate or cancel Ihe provision ol any olher slate or�ocal law regulaling construclion or lhe per(ormance of <br /> conslruclion. That I am aulhorized by the o�vner o(this property lo perform ihe work(or which application is made and I comply with the <br /> State Conlractors Law 18.27 R/CW a�u1296200 WAC. <br /> ' %� - `- /�/l��u <br /> Sic�nalure o(OwnedContractodAulhorized Agent Cale I/ <br /> L------ --- -- - - - ------------- L <br />