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, cRMIT APPLIC�T� ..1N <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 /> APPL!CATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 2216 3 6��' s�- oos�600 � ��ooa , L ;i� ��o <br /> LEGAL LOT N0. BLOCK TRACT OR SUBDIVISION p <br /> DESC. � � p���` Q I <br /> OWNER ADDRE55 CITYIZIP PHONE <br /> (, ��w�e.f4 �P.c.;�,•� I �2l6 36+ti � , ��e.� tizs- ZBO- b�iuy <br /> �ar � `-�Ch✓�o� TtiveS�-v�.,�-CS <br /> TENANTNAME CONTACTFORPERMIT PHONE yZS " 32S7-ZZg7 <br /> Y I <br /> � O✓1�(� � �nw�rp,� �c�N-Q�/ E•MAIL Cc�r-�ron�'Lul1�2V�V;=� i;r �-o <br />� CONTRACTOR ��I��J� ^ � t , �L ADORESS qTY21P PHONE <br /> � F <br /> l�rl5 Vt,1��, L Is Iz3 3�- �I. �E yZ5-367� ZZ82 <br /> CONTR. LICENSE# Int�C`�C1—� 1 L� �� <br /> w D��NII, a8al`[ <br /> USE OF BUILDING C _-Z HEAT SOURCE CONTRACT PRICE OF WORK <br /> L r'< <i�1- 1_K�5-�•,=� #� <br /> � — (�V�«,��1 _Eleclric �Gas_Olher � S]S <br /> 1- <br /> WORK DESCRIPTION <br /> PLl1MBING MECHANICAL <br /> NO. TYPE OF FIXTUF:C OR ITEM NO. NPE OF FIXTURE OR ITEM <br /> _ Toilet A'C-air handliny units I <br /> _ 6alhlub Forced air syslems I <br /> Lavalory (wash basin) Gas piping <br /> Sho�.ver Water heater i, <br /> Ki�chcn sink& disposal Gas(ireplace i <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> � Walcr healer tM����j L' x�S'�'+� Range hood <br /> Sink(service/badmop/elc.) � Exhaust fan <br /> Backflow prevenler Heal pump <br /> Urinal Unil heater <br /> Drinkinc� Founlain Boiler <br /> � Floor drain Refrigeralion <br /> Grease lrap Woodstove <br /> Roof drains Other <br /> Olher <br /> i <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify Ihat I have read and examined this applicalion and know the same to be irue and correct All provisions of laws a:id <br /> ordinaces governing this type of work will be complied wilh whelher specified herein or nol The c�ranling of a permit does not presume <br /> to give aulhoriry lo violate or canccl the provision of any olher slale or lucal Iaw reyulating conslruclion or the peAormance of <br /> construction.Thal I am authorized by the owner of this property lo periorm lhe work for which applicalion is made and I c�mply wi;h the <br /> S�ale Conlraclors Law 16.77 W and 296.200 WAC. <br /> � � -—" ^\ ���2 C/fl"� I <br /> SignaWre o wn C nt aclodAulhorized Ag� Dale - �/C � <br /> L-- -- --- — ---- r <br /> _ _—_ I <br /> I � <br /> 1 <br />