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I PERMIT A�PLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 ---- <br /> 425-257-8810- FAX 425-257-8857-www.everettwa g �'� �, <br /> \ <br /> APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 M � � �1�� — 0��,' <br /> SITE ADDRESS PARCEL TAX!.D.# PERMITYt'f <br /> Z I ' � • 5� �aZ� D�- <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION 71 <br /> DESC. <br /> OW ER ADDRESS CITY2IP PHONE i <br /> l�r�a�rc� u.{�s 21 I� `f(o�s�: � f�r, 1�4 �3 <br /> TENANT NAME CONTACT FOR PERMIT � PHONE//7S 7 1m�`�rt <br /> <<�aOo�- �'��� r <br /> " 51L(�N� .P�� e�rna�i�F�b'tiuc�`�a <br /> i CONTRACTOR ADDRES CITYIZIP PHONE <br /> �-{�(,0 C(5�l)Sf/'wc,�(cVw�I.�C• Z91Sf�,�i11`ri� ���wk 9�,z�1 <br /> CONTR.LICENSE# <br /> f}-4toccr9s���D �� ZS�- 3rS7� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �j�� /�. Electric �Gas_Other �Zp��;�� <br /> WORK DESCRIPTION <br /> � �,r� f Yr+� �ftr,�. '1� 1�-�IL6u+,�S-5cw.�,Qp-��-• �sl�s � 1�f4�%�- <br /> �iu�u� I�u ic� �(�.�c- s� luy�r,.�e;e. ���+ t���• <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Tnilet A/C—air handling units <br /> BathWb Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Sho�ver Water heater <br /> Kitchen sink&disposal Gas(replace <br /> Dishwasher Gas range <br /> Clothes washcr Ciothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/etc) Exhaust fan <br /> Back9ow preventer Heat pump <br /> � Urinel Unitheater <br /> Drinkmg Fcuntain Boiler <br /> rloor drain Re(rigeration <br /> _ Grease trap � Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify that I have read and examined this application and know the same to be true and correcf. All provisions of laws and <br /> ordinances�ovemi:ig this lype of work will be cnmplied with whetner specifed herein or not The granting of a permil does not presume <br /> to give authon�y tc violate or cancel the provisior of any other state or local law regulating construction or the performance of <br /> construc- n. That I am authorized by the owner of ihis property to perform the work for which application is made and I comply with the <br /> State C ractor La t8, 7 RCW and 296200 WAC. <br /> � • � -- — <br /> � 0 It� <br /> Signaty f ntractor/Authonzed Agent ate <br /> L� <br />