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PE�ZMIT 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 PiN 7_a j�D C� <br /> SITE ADDRESS PARCEL TAX I.D.# ERMIT# <br /> ��o� �r �RF v �_ �,- cosq2sao9oa�o� l Ql� -040 <br /> LEGA LOTNO. BLOCK TRACT � 1 �'1 <br /> DFSC. '� � � (3 c v.z�„ I f'i � rI5 V � ✓ <br /> Ra � � �rr ���rCu � C lyAO4F�Ir �UCC Fi✓ �C'Uer��E PHONE <br /> � Y , � R?c i <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> N� R2�,� 1� ,� � ��a��y ��Z�) 3 �S-1�6�'6 <br /> CONTRACTOR ADORESS ITY21P PHONE <br /> hhl5 Ifo�e r .,,Provei�e�� � �7SJ5 77Ea D,Q S� <br /> serul � e .Tnc �3(�0� 563- G609' <br /> CONTR.LICENSEi! S+�cko�N�S� w�, 98z-90 <br /> I-irS Hdrso:�o,� (.(_l3T lo0172g�`T6 ' � '��� <br /> USE OF BUILDING I HEAT SOURCE ONTRACT P CE OF 1'�ORK <br /> L�✓ .�.c� SP.<c� nd <br /> (�rt.ra,e � Sh e�i, -�t�r-�-,... _Eleclric _Gas_Other � 2 v � 0 0 C7� <br /> - `�/` <br /> WORK DESCRIPTION , ,,/� /25��7� — <br /> ` � ����C1"c�'e�' '..�.�C/J� /�C/1�G1�J� (I�G�GGIL/ <br /> - � / <br /> PLUMBING �t�o � MECHANICAL N o�. <br /> e <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilcl A/C-air handling units <br /> BalhWb Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Shower W ater heater <br /> Kitchen sink 8 disposal Gas(ireplaco <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(servicel6admopletc.) Exhausl tan <br /> Back(low prevenlor Hcat pump <br /> Urinal Unil healer <br /> Drinking Founlain 8oiler <br /> Floor drain Re(rigeralion <br /> Grease trap Woodstove <br /> Rool drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerili(y lhal I have read and examined this applicalion and know Ihe same to be Irue and correcl All provisions of laws and <br /> ordinaces govemin�this lype of work will be complied with whether speci(ied herein or nol.Tiie granting o(a permil does not presume <br /> lo give authority to violate or cancel Ihe provision of any olher slale or local law rec�ulating wnsWclion or lhe pertormance of <br /> construclion.That I ain aulhorized by Ihe owner ol this prcperty to pedonn Ihe work(or which application is made and I comply wilh ihe <br /> Slale Conlrac�ors Law 18.27 R W and 296.200 WAC. <br /> i <br /> ��� ���� , <br /> SlgnaWre OwhedConlra�todAulh rized Agent Date �/Z <br />