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P�RMIT APPLICATIt,�'J <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 70 4 PM -DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.iF P�RM�LL �� <br /> ,��Oa �o,C/ckJt �Vfn, � ���L! - � <br /> LEGA LOiNO. BLOCK TRACT 7 <br /> DES0. ��S�����/ <br /> OWNER AODRE55 CITYlZIP PHONE <br /> �v e,t_t:-s- <br /> �t.���� /�vrc��e•.�, �aos ,P�.�k�.� A�.� ?B.:u� Y�s- �s9-a�sy <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> S�InJL L:Nn.9 /�ViC.( h y ��F(�, SA/�.E <br /> ! <br /> CONTRACTOR ADORESS CITY2IP PHONE <br /> �LL�7.V �'✓�[./CT� IICI( �/>.�.o ��h. fo. <br /> f.N�nL .�,�� y���-c�a� <br /> CONTR.LICENSE# � � � ,-�n���� <br /> rRh!'Cs 9S`�Qca �/�-P I�y% , /r��.n t/ ��✓ r. �.�.� <br /> USE OF BUILDING I — H�AT SOURCE I �ONTRACT PRICE OF WORK <br /> Eleclric Gas Other <br /> WORK DESCRIPTION S'H,�G�4 �J�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> _ Balhlub Forced air syslems <br /> Lavatory(wash basin) Gas piping <br /> Shower Waler hea�er <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gasranc�e <br /> Clothes washer Clothes dryer <br /> laundry iray Range hood <br /> Sink(service/bar/mop/etc.) Exhausl tan <br /> Backflow preventer Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeralion <br /> Grease trap Woodslove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I have read and examined this application and know the same to be true and correct. All provisions of Iaws and <br /> ordinaces governing Iliis type of work will be complied with whether specified herein or not.The granling of a permit does not presume <br /> to give authonty to violate or cancel tha provision o(any other state or local law regulating constniction or lhe perfortnance of <br /> conslruclion.Thal I am authorized by the owner of this property to per(orm lhe work for which application is made and I comply with tha <br /> Stale Contractors Law 18.27 RCW and 296.200 WAC. <br /> ��`��— !� '� 5/ 3/�c� <br /> SignaWre ot OwnedCoNractor/Authonzed Agent Date <br />