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P�RMIT APPLICATIdN <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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 9901 , �l�� R.S a I t� ' lr� - <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. � �7 "CUJP Z R(O� ��J' GLIV Or �GU� ,�.p uo 33— (p <br /> OWNER ADDRESS CITY2IP PHONE <br /> IJA�UG4� Fl�uDE11�t�1� �='i0l �� �� 5�, �U�It�i� �bY���-IS� � , <br /> TENANTNAME I CONTACTFORPERMIT PHONE i'I <br /> �c-�s= �/zc� yz5=�$3 -S�i�}�l <br /> CONTRACTOR A�DRESS CITY2IP PHONE <br /> ►!l�tL-�t�T {'Ul EL-1f�k�UlU1L� �/�.�C. �C-�1[.tO�xl <br /> CONTR.LICENSE# g�3 p ��3���. ,V� �125-�6f�3 Sa`ii � <br /> _VVIL-Rti►ti1L�Ce,3ClN1 �'1�OS�Z �,�,; i yk <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> S F 1] _Eleclric �Gas_Other I ,O, �f D ' ��' <br /> WORKDESCRIPTION �-�,���LL. /l�Ew �P�'g �+,-����L w/r/f /} ,(,JE!(� <br /> �C-f�7—/"LC r✓!P <br /> PLUMBING MECHAIdICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI:(TURE GR ITEM <br /> Toilet � A/C—airhandlingunits <br /> Bathtub Forced afr systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Ciothes washer Clothes dryer <br /> Water healer Range hood <br /> Sink(service/bar/mop/elc.) Exhaust fan <br /> BackFlow prevenler � Heatpump <br /> � Urinal Unit healer <br /> Drinking Fou.itain Boiler <br /> Floor drain Refiigeration <br /> Grease lrap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and cort�ct. All provisions of laws and <br /> orcinaces governing lhis type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give aulhority to violate or cancel the provision of any other slate or local law regulating construction or the performance of <br /> constructio�.That I am authorized b e owner of this property to peri��rm ihe work for which app�ication is made and I comply with the <br /> State Contractors Law 8.2 RCW 296200 WAC. <br /> Signature o w d ntractor/A onzed Agenl ate <br /> \� � <br />