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� � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES � �ac� _og <br /> 3200 CEDAR STREET, EVERETT,WA 98201 S O g0 3�b�j <br /> 425-257-8810-FAX 425-257-8857-v:nrr.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS [3q Y5 �0e f�q 21L PARCEL TAX I.D.# NERMIT# <br /> 12�1 23�9 5rRerr f�E2E7r� I,�A q$Zc� � r' <br /> s� �.�;� <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> ONMER ,4�DRESS CIiY/LP PHONE <br /> �r�Ty pr �.��rttrT P/{2KS Y�oZ �.M�F��rEa Pov:.evnap <br /> �x �'�G2rnTw..+ QGpA2rrip,v� C-ve2r rr wA 98Zc3 •z���` �'ZS- 2S7-�Jjoo <br /> TENANTNAME CONTACiFORPERMIT PHONE <br /> crr�' o� �Jr�-CTT �A2�c5 I HE�v2Y SC►�rtoi��2 �1zS - 25�7 - � 37Z <br /> & �tLRI-ATu%N QCPA2Tr�f�u7- <br /> CONTRACTOR ADORESS CITYRJP PNONE <br /> TF��� /�Fr�/l P2o�E�r pID <br /> CONTR LICENSE/ <br /> USE OF BUILDING HEAT SOURCE N �? CONTRACT PRICE OF WORK�k�y � <br /> C I'TY 1'/12 �L _Eledric _Gas_Other / _� <br /> WORKDESCRIPTI P/JR�[ 2tNeV o,� - CuNSrn� � .+ aF CJN� E A <br /> Si "wn� � UC�c ' LiE.) � �ONG er� 2etK Y C p ACa Pnu s � ���. <br /> = P� 2 S 5 6 � t � f� I A� . r �i� - <br /> M� 5 i�,v '� S �c� ��iNC,S A,..p Sr ���nnY � � crtii .M� �� - <br /> io,v L`�1' tN[li 14ni�C ! <br /> PLUMBING MECHAN�CAL <br /> NO. TYPE OF F�XTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handlirg units <br /> Balhtub Forced air syslems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water healer <br /> Kitchen sink&disposal Gas fi2place <br /> _ Dishwasher Gas range <br /> Clothes washer Ctothes dryer N�� <br /> Laundry tray Range hood <br /> Sink(service/barlmop/etc.) Exhaust fan <br /> BackOow preventer Heat pump <br /> Urinal �. Unit heater <br /> Drinkipg ounta' _ Boiler <br /> ,� bordrein tNc 2n,:.5 r•n. SiOew��KJ Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> —I — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read ancf examined this application and know lhe same lo be true and corred. All provisions o(laws and <br /> ordinaces governing this type o(vrork will be complied with whelher specified herein or not.The granting of a permd dces not presume <br /> to give authoriry to violate or cancel the provision of any other state or local law regulating wnstrudion or the performance of <br /> construction. That I am authorized by the owner of this propeAy to perfortn the work for which appliration is made and I comply with the <br /> State Contractors Law 18.�7 RfCW and 296.200 WAC. <br /> -�-`-�'Y I"`,/�G�'�-�,rc�--- 3 - I o - 0 8 <br /> Signalure of O�edContractor/Aulhonzed Agent Date <br />