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— — —� <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDP`. 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 <br /> SITE��A DRESS PARCC•L TAX I.D.# P(E�RMIT A,���' <br /> �'E�� " �� �:ti1 � �' ���� ' JOr��J " . <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION fl <br /> DESC. <br /> OWNER ADDRESS CITYlZIP PHONE <br /> I�lu- S�ttc�,?r- I s1�r�t��t��' Po P�''� ��S`t C—v�tLtT a2s-2��4`��� <br /> TENANTNAME CONTACT FpOR PERMIT PHONE 1 jy�'^i5'� ^p'�n L G. <br /> Y�•�l�''L(� ��FJ rG�EI'L MC�LUI.Ih�� E•MAIL Pf1C'w�nMU�i47��d� r�t� <br /> Cp ����vp�j QC1�J�'kl�C�—� I�:.. DDRE , J ITY/ I� <br /> �� �5�27- �� �e,'L �h�t� <(2�-343 �IZ <br /> CONTR.LICENSE# �Iu� <br /> ��\qN� OG �1 �=C� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> E).o,_� <br /> ���� � � _Eleciric _Gas_Other 6 ao, ���� ,.,. <br /> ��� <br /> WORK UESCRIPTION <br /> �{� o sq��e s� C�� ���t�..'�to usL 51��?�e.C. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR IT[M NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A�C—air handling units <br /> Balhtub Fomed air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Sho�rcr Waler heater <br /> Kilclien sink 8 disposal Gas(ireplace <br /> Dishwasher G2sranae <br /> Clothes washer Clothes dryer <br /> Water healer Range hood <br /> Sink(servicelbadmop/etc.) _ Exhaust fan <br /> Backllow prevenler Heal pump <br /> Urinal Unit healer <br /> Drinking Founlain _ Boiler <br /> Floor drain Rn.(rigeration <br /> Grease Imp Woodstove <br /> Roof drains Olher_ <br /> Other <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I have read and examined this applicalion and know lhe same lo be lrue and correcL Ail provisions of laws and <br /> orAinaces 9ovemin9 this rype of work�vill be wmplied wilh whelher specified herein or noL The granting of a Narmit does not presume <br /> to give zulhority lo violate or cancel Ihe provision of any olher slate or local law regulaling consWction or the perfomiance of <br /> ' conslru . That 1 ai authorized by lhe owner o(this property to perform the work(or which application is made and I comply wi!h the <br /> � S�le C ntrac ors La \827 R W and 296200 WP,C. <br /> !� ����i�, �\.\�w.���� �d 27� 2op g <br /> Si�nalure ol O�vnedCvNnctorlAulhorized Agent Date (/ <br /> I � <br /> �-- — -- ----- — <br />