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t <br /> PERMIT APPLICATION <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 -DEBIT 3 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS 'L1�Yi'C.t+ y1/A PARCEL TAX I.D.0 PERMIT A <br /> � 1 ! 5 _�l�icw� ��C, �I4��7 4-3_�(� cct.c, i 3c ac L L. S� `/ C <br /> LEGAL LOT NO. '2 BLOCK TRACT <br /> ✓ <br /> oesc. _�i � �( cu;��.l<�- �Gi . �iq 1 bti'i 1 Z`l h G � l. bV,hf. <br /> ONMER � ADDRESS ' CITY P PHONE ���.Z� � <br /> � 1[;I�n '� G>Ic��v�.uC� �C� I�b.� �l _;11> ��I�c�r� f1t'C. 6V'cwii� `I4ZG�� �i�-C'`IiS <br /> TENANT NAME CONTACT FOF PERMIT PHONE <br /> �' l Iv�+�cC Nf�tCat u- 'CL � <br /> �'�'U��(i �t �� OlL�11C-1' / �>11��I.A�uc 1Vi HI-.�11 ��Z`>- ii3 'C''11`. <br /> CO TRACTOR 1.�,�����C1 C.(��I�FI�tiLrt�+q�r1��,ADDRESS CITYTP PHONE <br /> � /„ � ���iK� I�C� �LEo._ q�'l Z9M- <br /> SCl f"it, L /flk� <br /> CONiR.LICENSE t (.O�-��TG 1�16.F,J;�� \ 6 � � ��� - . ' ;-r� -� <br /> t ���/C�l 1 �L-1,i 'F.,_ 345�. < <br /> USF OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> IL `��1 c1C� 7LL. Elednc ✓Gas Other <br /> WORK DESCRIPTION <br /> {� <br /> �f_r�i�.�ic_ I o� t�C�S�-i� •�+ l�,��I ��{�� �vi� <br /> / <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilet A/C-air handling units <br /> 1 Bathtub Forced air systems <br /> Lavalory(wash basin) � Gas piping <br /> i Shower Water heater <br /> i Kitchen sink 8 disposal Gas fireplace <br /> � Drshwasher I Gas renge <br /> Clothes washer Clothes dryer <br /> Laundry tray I Range hood <br /> Sink(service(barlmop/etc.) � Exhaust lan <br /> Backfiow preventei Heat pump <br /> Unnal Unil heater <br /> _ Dnnking Fountain Boiler <br /> _ Floor drain � ReMgeration <br /> Grease trap Woodstove <br /> Rwf drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 1105 <br /> 1 hereby centify Ihat I have read and examined this applicatlon and know the same to be true and correcl. AII provisions o(laws and <br /> ordinaces goveming this type of woAc v+ill be wmplied with whether sped6ed herem or not.The grenting of a pertnit dces not p2sume <br /> lo give authonry to violate or cancel the provision o(any other state or local law regulating construction or the pertormance of <br /> consirudion. That I am aulhonzed by lhe owner of this property to peAorm the work for which applicalion is made and I comply with the <br /> Slate Contractors Law 1827 RCW and 29fi200 WAC. <br /> �,,,�Lc-1� l�r�-.�..i. Li_�,t�.e.j..:_�l `�- L':) ' �J <br /> Signatu of OwnerlConlrector/Authonzed Agenl Date <br /> l�.I <br />