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�', PERMIT APPLIC�►TION <br /> � CITY OF EVERETT PERMIT SERVICES <br /> I 3200 CEDAR STREET, EVERETT, WA 98201 I <br /> � 425-257-8810— FAX 425-257-8857—www.everettwa.org i <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM �l ` `�� -0� <br /> I SITE ADDRESS PARCEL TAX I.D.�I P RMIT� � <br /> sa�asek-h,�.�st o� 3�S0000a-a-oa '� � �- �� <br /> LEGAL LOTNO. BLOCK TRACT � � <br /> D[SC. <br /> IIOWNER ADDRESS qTY21P PHONE <br /> �I�v�`d ��d�,s sa�oa�e�.�t�. �� 9�2n� �a�-a�,-,�-� �� <br /> � TENANT NI1ME CONTACT FOR PERMIT PHONE �I <br /> I �tti� Jec�- C�r-- 3�0 -�3s—l�I fo _ � <br /> I CONTRACTOR �1, I �yn(� Cn,.��'��� ADDRESS ��(��Q ���.i..,�rCITYl21P PMONE �� <br /> VV 1 a�� Vl/I ./� �lU<%l�' Qp y� <br /> � CONTR.LICENSEN�I.WENE�RI /N77 '�I� !4Y ����'�.• (O�1�� 360��1✓-�—I /I � I <br /> � l � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK �. <br /> ��� _Electnc �Gas_Other # f��UV � "� II <br /> WORK DESCRIPTION I <br /> a��5-� �s eo �ller� � 5�s iv��r-1� � �- � 5as 9�rr,�e �-�er. ; <br /> PLUMBING MECHANICAL � <br /> NO. 1YPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Todel _ AIC-air handling uniis I <br /> Bathtub Forcetl air systems � <br /> Lavatory(wash basm) � Gas p�ping <br /> Shower Water heater � <br /> _ Kitchen smk&disposal � Gas fueplace i <br /> Dishwasher _ Gas range <br /> Clothes washer Clothes dryer , <br /> � Laundry tray _ Range hood I <br /> Sink(serviceibar/mop/etc.) Exhaust fan , <br /> � Backflow preventer Heat pump <br /> _ Unnal � UnR heater 'I <br /> Dnnking Fountain � Boiler <br /> Floor dram Refngeration �. <br /> Grease trap Woodstove <br /> Rool drains Olher . <br /> Other _ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby cerdify Ihat I have read and examined lhis applicahon and know the same to be true and cortect. All provisions of laws and I <br /> ordmaces goveming this type of work will be complied wdh whether specified herein or not 1he granting of a permR does not presume <br /> to give authordy to violate or cancel lhe provision of any other state or local law regulatmg construdion or the pertormance of i <br /> ccnstruchon. That I am authonzed by the owner o(this property to pertorm the work for which appticallon is matle and I comply with the <br /> State Contractors Law 1827 RCW and 296200 WAC <br /> � �(,�G�a- � .� �(/la /D � <br /> Si iat .e of Owner/Contractor/Authonzetl Agent Date � <br /> i <br />