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� � <br />� P�RIV�IT APPLICATIC,�V <br /> CITY aF EVERETT P�RMIT SERVICES j <br />� 3200 CEDAR STREET, EVERE'T'f", WA 98201 <br />� ,,,..'.1 425-257-8810— FAX 425-257-8857—www.everettwa.org I <br />"�� ' APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />+ . SITE ADDRESS � I PARCEL TAX I.D.# PERMIT# � ,� II <br />� ' � 5fi fl V�i �V2re-I� UJ r`O��,c`� 10 I�O I~l�_� SZ>� - `s <br /> . LEGAL LOTNO. BLOCK TRACT I <br />'��-ti ��� DESC. I <br /> OWNER ADDRESS CITY/ZIP PHONE � <br /> . . L � N��1 ���-t�-I- �1-� �� (� l�, �.i � <br />�'�`��;'� TENANT NAME CONiACT FOR PFRbIIT PHONE �I.�Q � <br />�, ' L � �. S� l�1E �C. ��5;. �( I�r�-, I G�� 5� J�� �verc�H 1��.� . ��J I�OJY� <br />��.,, "' � CONTRACTOR �� � AD RESS CITY/ZIP PHONE - ' <br /> � " Mona -f-t�vc�ra�to _�co ����� � �`.;-`�'�' ; <br />� CONTR.LICENS6,# �{�,(F �(;!�j ��� I(;' <br /> c-�.�:� 1 ...� /��� c:L <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF VdORK <br /> �n ! � � Electric �Gas Other ' <br /> `j,� � ;�.�vt a.- — — — ��'�(( l� -f-�; � � ;f: <br /> WOR DESCRIPTION <br /> /� <br /> " I�P n �f ,�� ��+ � /o � �t�'� ;� <br /> i <br /> PLUMBING MECNANiCAL � <br /> NO. TYPE�F FIXTURE OR ITEM NO. TYPE OF PIXTURE OR ITEM �� <br /> Toitet A/C—air handling units <br /> Bathlub Foroed air systems <br /> Lavatory(wash bas�n) Gas piping <br /> Shower Waler heater ; <br /> Kiichen sink&disposal Gas fireplace <br /> Dishwasher _ Gasrar.ge <br /> _ Clothes washer Clolhes drye; <br /> Laundry tray Range hoo,1 <br /> Sink (service/bar/mop/etc.) Exhaust(an <br /> Backflow prevenler Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Re(rigeration <br /> _ Grease trap Woodslove i ; : I <br /> = Roof drains = Olher I <br /> Other <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this applicalion and knew the same lo be true and correct. All provisions of law;and j <br /> ordinacesgoverning this type of work will oe complied with whether speci6ed herein or not.The granting of a permil does not presume <br /> M yive aulhority to violate or cancel Ihe provision of any other state or local law regulating construction or Ihe performance of <br /> cons(ruction.Thal I am aulhorized by the owner of this property to perfcrm the work for which application is made and I comply wilh the <br /> State Contractors Law 18.27 RCW and 29G200 WAC. <br /> t_ ll;.�(.{ ( �� ��1 %l�U�/� <br /> Signatura of-0wnedConlractodAuthonzed P,gent Date <br /> '/Z <br /> y '_ p Il �' <br /> � -- _ ��t'�� 3� ..�,is^L�z-v�i. .wt' � }J�.:,ii . .. .� <br />