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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 ACCEP7ED FROM 8 AM TO 4 PM ,� ��� - CI� <br /> SITE ADDRESS PARCEL TAX I.D.� PE IT# <br /> 3811 SIMIhF �J� O '7 �60000 ' <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. ,�('f i)-07-NI 1 T �'l. Z L W��� Or �9LL��`( <br /> OWNER ADDRESS CITY/ZIP PNQNE <br /> �LL�� F.�1MlL; I,G.C. /7/I CJ)C-LMDOP 1-�fNf= Lv��'EI/ `r',ZS -}y�' S`/�'�` <br /> TENANT NAME CONTACT FOR PERMIT PIiONE <br /> �,Oy£LL IM�"Cr �4RN'L CR��.JFoR1� '�2S-Z5� ^ ��LZ <br /> I2c-34 - i2Z <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> �uA�A�rG G • CWFW FvRD�1'nl L 9k1� ro�,x.f� �ke� ��nr.rrr�w� p <br /> CONTR.LICENSE# L�.��� '�ZS'3�3'O �ZL <br /> �T�iQ f �C I D 1 IL fr -� <br /> U5E OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> {(��}=(� 1.�� S f-�n I _Eleclric �Gas_Olher �/t,p�! � �(�v , �y <br /> WORK DESCRIPTION , <br /> D� �rPf £1CIST��JC rJi��Gf Fv.L Al� OF-F�cfS � O�f-T�f'PlJd�+t ��+tc�/'� KIT+�tff.t.)/ <br /> u�.,,� Lr � ffTS / CA-.tPgT � T�Gf <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. � � TYPE p�F�I tTU��R ITEM <br /> �� � <br /> Toilel _ C—air handling units <br /> Bathlub _ Forced air systems <br /> � Lavalory(wash basin) _ Gas piping <br /> Shower _ Waler healer <br /> � Kilchen sink&disposai _ Gas firep�ace <br /> Dishwasher _ Gasrange <br /> Clolhes washer _ Clothes dryer <br /> _C�, Walcr healer _ Range hood <br /> Sink(service/badmop/elc.) _ Exhaust(an <br /> BackOow preven�er _ Heal pump <br /> Urinal _ Unit heater <br /> �rinking Fountain Boilcr <br /> � Floor drain Refrigeralion <br /> Grease trap _ Woodstove <br /> Roo(dreins Other <br /> Olher <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby ceri!ily thal I have read and examined this applicalion and know;he same lo be lrue and correct. All provisions of laws and <br /> ordinaces governing Ihis rype of work will be complied with w��elher specit��d herein or noL The granling of a permil does nol pmsume <br /> lo give aulhority lo violale or cancel the provision of any olher slate or local law regulatinc�construction or ihe perTormance of <br /> conslruction.Thal I � i authorized by tl e owner o(lhis property to perform the work for which application is made and I comply wilh the <br /> SI ctor a 18.27 RCW anc 29G200 WAC. <br /> s I-� (o <br /> Sign O� er onlreclor/Author ed Agenl Date �( L <br /> I <br />