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PEkMIT APPLI�ATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVEP,ETT,'v",�A 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.iM ,g ERy+IT� <br /> ZZ�-! u�l�rluvr� f}ur� l5 (.P (l -b�� <br /> LEGAL LOT NO. BLOCK J-Z`� TRACTS'UPP I���- OF C(t U(LC}� �, Lf'�I�'�W I Lr� <br /> DESC. 28-Z� y�� <br /> OWNER AODRESS CIN21P PHONE J2(' 2)'f <br /> T�A�✓iH� rni4R.ri�vrrz iz Z y cu�ru�a�� .�u�2�:r u.�a vrz� . �z co <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> Q �N�/�J /�7JI�Zf1E1✓ �/z I= 2 S y-7Z�� <br /> CONTRACTOR�U�.L�� ���K��C ADDRESS��� ,2oyy CITY2IP PHONE yl�-_. Zsy� <br /> r��/�� 7250 <br /> CONTR.LICENSE# Q�L O/ <br /> USE OF BUILDING HEAT SOURCE p CONTRACT PRICE OF WORK <br /> Gl1KE1� Electric Gas Other ��y�S� � <br /> WORK DESCRIP710N <br /> coNs77Z�'cT�oN a1= A Z`/' x� 4 ' u�oo:7 f2�4�(r C9+v2HCrc <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM N0. TYPE OF FIXNRE OR ITEM <br /> Toilet A/C-air handling units <br /> Bathtub Forced air systems <br /> Lavalory(wasli basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas tireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water healer P,anc�e hood <br /> Sink(service/bar/mop/etc.) Exhaust tan <br /> Backflow prevenler Heat pump <br /> Ur,nal Unit heater <br /> Drinkinc� Founlain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodslove <br /> Roof drains Olher <br /> Other <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS J705 <br /> I hereby ceriti(y that I havr. read and examined this application and know ihe same to be true and correcL NII provisions of laws and <br /> ordinaces goveming this type of work will be complied wilh whether specified herein or noL The granling of a pertnit does not presume <br /> to give aulhonty to violete or cancel lhe provision o(any other state or local law regulating construction or the performance of <br /> construction.That I am authorized by the owner of this property to peRorm lhe work for which application is made and I comply with the <br /> Slate-Cent(a Law 7�. RCW and 296.200 WAC. <br /> �/����-°�-c�L� /�- ! y �Q�Cc <br /> ignature of Owner/ContractodAuthorized Agent Date �� <br /> Z <br />