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� PERMIT APPLICATI �GN� <br /> CITY QF EVERETT PERMIT SERVICES I� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 �"'� D I ��DI <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.i� PERMIT# <br /> � <br /> I C�L ZS�'' ��� s��, e�-"�Ia.-� -c.�o -c�-�L- �c� <br /> '.EGAL LOT NO. BLOCK TRACT OR SUBDIVISION# �/�J^�/�2.Z�—O 7 <br /> oesc. �� Z �a,�lxil's S�vr C-�nrorNS `f� Gti <br /> 0'NNER ADDRESS CITYIZIP PHONE <br /> �43✓�ti�r' �FNn /.11li4•-,., N � e�a zy iusi`sr 5�.•; �vufcN`1�wni�9- �-!2S• 3 �/ � `�3�! <br /> TENANT NAME I CONTACT FOR PERMIT f'HONE 4�y , ..�Z 3 _�-�� g <br /> G,y u t� e'S��l� C��- <br /> E•MAIL <br /> CONTRACTOR A7DRESS CITYIZIP PHONE <br /> �, ��a���'�. C{���U:}�z'��LLC. �'l'J7�-3a�A�� SL ��,�-\�� t?�(�- "1`-�3 ' L—[1$ <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WOR�< <br /> ..w1�Ja.k 2l01��, .Q/_� <br /> 5 `��')�'z' r```�'�`s"� __Electric �'Cias_Other Ze�� �.� <br /> WORK DESCRIPTION <br /> �—�j� � ��/.�1�� ��� u� <br /> PLUMBING MECHANlCAL <br /> NO. .YPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet � A/C—air handling units <br /> /:r BalhWb Forced air systems <br /> � Lavatory(wash basin) �` Gas piping <br /> Shower Water heater <br /> Kitcl?en sink 8 disposal � Gas fireplace <br /> _�__. • Gasrange <br /> l Clol es washer �_ Clothes dryer <br /> Wat r heater � Range hood — 01���0 <br /> i Sin (service/bar/mop/etc.) ,'�. Exhaust(an <br /> B ckflove prevenler Heat pump <br /> rinal Unit heater <br /> — �nnking Fountain , Boiler <br /> loor drain Refrigeration <br /> Grease�rap Woodstove <br /> � Roo(drains Other <br /> ! Olher <br /> CITY OF EVERETT LOCAL SALES TAX�ODE IS 5105 <br /> I hereby certify that I h�ve read and examined this applicalion and know the same lo be lrue and correcL All provisions of laws and <br /> ordinances goveming this lype of work�vill be complied with whether specified herein ornot. The granting of a permit does not presume <br /> lo give authority to violate or cancel the provision of any olher state or local law regulatir.g conshuclion or ihe performance of <br /> construction.Thal I am authorized by the owner of this property lo perform�he work for which application is made and I comply wilh the <br /> Slale Conlraclors Lavi 18. CW and 296.200 WAC. <br /> /. ��� z'��Q <br /> L <br /> Signature o(OwnedCont�tor/Authonzed Agent Date <br />