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rERMIT 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 I 2 —Uc4 –O� <br /> SITE ADDRESS PARCEL TA%I.D.# PERMIT# <br /> 2c�0 T��t� S�r„�-L �i�Q��� <br /> LEGAL LOT NO. ELOCK TRACT OR SUBDIVISION tt <br /> DESC. <br /> OWNER ADDRESS CIN/ZIP PHONE <br /> �vCC� <br /> TENANTNAME CQWTACTFORFERMIT PHOREL�Zi C�O.Z-�sORS <br /> /� � I � �\ n I f � <br /> JGG�.'�/� l..e✓IK/ JDL�� � LC_CTC�TCL�) E�NIAIL D�^`+.fi((.C �iVa-}Cc�.. <br /> ��'�O ADDR— E—S— I .l�—�N�E Co <br /> j: � . . : '/, � � .;`� . , > �' ,� <br /> CONTR.LICEIJSE p i � , � . <br /> USE OF BUILDING HEAT SOURCE ONTRACT PRICE OF WORK <br /> � �Eledric _Gas_Other � "iC��— �j� <br /> I <br /> WORK DES���P�pNro J /���J '7�Ll�cCiC '�✓AG f�vl�l l I r1 -lt,v�� (Y('/ic4�ktHT)� QnG �L <br /> KG f� <br /> a � <br /> o � ro�-I�p cx��,s� �-� -!v �„�:�1�� n��.,� c%�„�1 sp..ti . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITeM <br /> Toilet A/C-air handlinc�unils <br /> Balhl�b Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Walen c�ater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryer <br /> Waler he2ler Ranc�e hood <br /> Sink(serviceNar/mopletcJ _ Exhaust fan <br /> Back(low prevenler _ F;eat pump <br /> Urinal Unit healer <br /> Drinkinc� Founlain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease lrap _ Woodslovc <br /> Roof drains Other_ <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify lhal I have read and examined Ihis applicalion and know the same to be lrue and correcl All provisions of laws and <br /> erdinaces ycverninc�this rype of work will be complied with whether specified herein or noL The granting of a permit does�ot presume <br /> to give aulhority lo violale or�3ncel ihe provision ol any ol!ier slale or local lav+regulating construclion or lhe peAom�ance of <br /> consiruction.Thal I am aulhorized by lhe owner of Ihis propedv to pertorm the work for which application is made a•, . i comply wilh ihe <br /> Slate Conlraclors Law 18.27 RCW and 2�J6.200\NAC. <br /> Sign2lure o(OwnedConVaclor/Au�horized A9enl Dale <br /> ��U <br /> � ------_ _ _--- ---� ---- -. <br />