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. c <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PLRMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICAT�ONS ARE ACCEPTED FROM 8 AM TO 4 PM a'�-3�� <br /> SITE ADDRESS 5%+��'^C O PARCEL TAX I.D.p PERMIT A <br /> ' 1 �`j J•y �„-,--s ��,ve< �3 I N �� <br /> LEGAL LOTNO. BLOCK TRACT ` <br /> DESC. <br /> OWNER �\ ADDRE55 C�TY21P PHONE <br /> 1 V`4.c..�, Uev�t�0{�i'�1�+�� �-.LC ��n-`� ,�i•'b✓ / �SS.t•�y„� <br /> 'Sn_�,�,..n�w�.�l. �� �+-!07 'i.Y9 � <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> 1 , 1 /� � <br /> R�s„� tt��it.�e �eituKr�.,��". /� �ny�- �u����,� 360 - -7`1 �1- 73ojo <br /> CONTRACTOR 1 ADDRESS 1 CITY2IP PHONE <br /> F��� F��-t r ��,�� u. ��,lyn.� S:sa �.� }- !�'�«,,n l�on ro� 3�;�-?��1� •�73� <br /> CONTR.LICENSE R � ������ <br /> �S��y� L�S �3�'1 R � <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> � � <br /> �-.3����.,�,�,�,1 ' _Ele:tric ��das_O:her � ��Q � <br /> WORK DESCRIPTION <br /> r ` t <br /> C^-:�s � i��-C �"/b,� wl�`�%',^ )s1'� ��=+1^-rl� 3� �.� <br /> PLUMBING MECHANICAL <br /> NO. NPE Of FI%NRE OR ITEM NO. TYPE OF FI7CTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathlub Fofcetl air Syslems <br /> Lavalory(wash basin) /�, Gas piping <br /> Shower Water heater <br /> I:itchen sink&disposa� Gas f replace <br /> Dishwasher 3as range <br /> Clolhes�vasher Clothes dryer <br /> Laundry tray _ Range hootl <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer _ H?at pump <br /> Urinal Unit healer <br /> Drinking Fountain _ Bciler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 1105 <br /> I hereby ceritiy that I have read and examined this application and know thA S9mA t0 b2 tN0 AAd CORACt. All p�OVISi011S Of IAWS 211d <br /> ortlinaces goveming this type of work will be complietl with whether specified herein or noL The granting of a permit does not presume <br /> lo give authonty to violate or cancel the provision of any other state or local law re�ulating consiruction or the perfortnance of <br /> construction.Thal I am au;horized by the o�rner of this property to perfortn th=work for which applicalion is mzde and I comply with the <br /> State Con,reciors Law 18."7 RC and 296.200 WAC. <br /> �� I -^.,ic�-s�r(�� `� ��.] '-�4' <br /> �i Signature of Ownerl onlractoriAut��n�edToent Date <br />