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�RMIT APPLICATIUW <br /> CITIf OF EVERETT PERMIT SERVI'CES <br /> 3200 CEDAR STREET, EVEREIT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � �c �--(f.6 <br /> SITE ADDRESS PARCEL TAX I.D.� PERMIT Jf <br /> ' L :1- 3 �� J �- S� �-� D � y�f v D ?�S� �� -vN <br /> LEGA LOTNO. BLOCK TRACT _ CI (�r� I � �•, 77 ! S� � � <br /> DES0. �� [ <br /> OWNER ADORESS CITY2IP PMONE <br /> ,'�A�vc- � L��fi y if'�7� ,� N ��` Il 6 !r �`S .P'L�Sr ��i 12;� s� <br /> TENANT NAME CONTACT FOR PERMIT y�s_Q�P�IONE �y�q <br /> AL��S�} N�i�N l-a �64 �3 � 49 � <br /> CONTR�S I N C IY l �-�{�'Y �"IS �ADDRE�7_� ✓!/ln! �A _ „ /,A� PHONE <br /> � y �wp ���/ kYs ���6� y <br /> CONTR.UCENSE 1t / �O d ` � <br /> IJC- S / yC��- 1 �U1"� I 1''�lr5fo <br /> �SE OF BHIl�INQ H AT SOURCE CONTRACT PRICE OF 1�fORK <br /> W+ ��Ny ti� � '�00% ' � 3 �vo ,od <br /> _Electric _Gas_ lher <br /> WORK DESCR T N�-` �� � O�V <br /> l� ��� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—afr handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas pfpfng <br /> Shower Water heater <br /> Kilchen sink 8 disposal _ Gus fireplace <br /> Dishwasher Gasrange <br /> Clolhes washer Ciothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> _ BackFlow preventer � Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain _ Boiler <br /> Fioor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL S4LES TAX CODE IS 3105 <br /> I hereby cerilify thal I have read and examined ihis applicaticn and know lhe same to be true and correct. All provisions ot laws and <br /> ordinaces goverr�ing lhis lype oi work will be complied wilh whether specified herein or not.The grarting of a pertnit does not presume <br /> to give authority to violate or cancel the provision of any other slate or local 12w regulaGng construcBon or the perfortnance of <br /> construction.That I am authorized by the owner ot lhis property to perform the work tor which application is made and I comply with the <br /> Stale Contractors Law 1827 RCW and 296200 WAC. <br /> ���ti�� 6�a1 �0 .6 <br /> Signalure o(OwnedConlra r/Authorized Agenl Date <br /> `IZ <br />