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PtRMIT APPLICATIGN <br /> CITY OF EVERETT PERIIAIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—w sverettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �� -�7�—(� <br /> SITE ADDRESS PARCEL TAX I.D.# I PERMIT# <br /> �vo� - a�f�� Pl 5�= a�o���c� 63G/�v0 1 �t� '- C>'; <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. � <br /> OWNER ADDRESS CITY2IP PHONE <br /> L /-1 2'/2-t� (�2N_'N M=vz— ,7��' '"/DU�'�-`�"t ` ' iCv�.?.E/f 9d208 yo7� �7-�6 <br /> TENANTNAME —� jONTACT�'R�`MI� PHONE q�$- y7d-747Y <br /> (��'�',y — flrL�.�r ,��� i� _ ^' . r•n E-MAIL 9SiGenSE�V[rlce��n I <br /> CONTRAC7 R G S I Cr�nB'�"µ�fi��^� _�^�� ADDRE S nD QaX ('jG�� CITY2IP H E�y�s` y�_74 <br /> � G��I J <br /> CONTR.UCENSEi! GSI�ST 9S7DA MiIICfeCK� t�A RgO82 , <br /> �afc �u25�7Y3-t16zG <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> -�jF,� �`�p �/� J Electric _Gas_Other *7���' �• <br /> WORK DESCRIPTION <br /> ..� wqrv; T� �io� /o ' 7Z� e'ti 5finic f .f�riJ i��cM �v2 ��ri�.a C�o��r <br /> � <br /> PLUMBING - ,vo Pl�.�b,�T �� /�1u1+�N�L4� — MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM �1 N0. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling unils <br /> Bathlub ' Forced air systems <br /> Lavalory (wash basin) _ Gas pipinc� <br /> Shower Water healer <br /> Kitchen sink&disposal _ Gas tireplace <br /> Dish�vaslier Gas range <br /> Clothes washer Clolhes dryer <br /> Waler heater Range hood <br /> Sink(service/bar/mop/etc.) _ Exhaust fan <br /> Backflow prevenler _ Heat pump <br /> Urinal Unit heater <br /> Drinkiny Founlain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease trap _ Woodslove <br /> Roo(drains Other <br /> Olher _ — <br /> CITY OF EVERETT LOCAL SALES TA7C CODE IS 3105 <br /> I hereby cerilify that I have read and examined this applicalion and rcnow the same lo be true ar.d correct. All provisions of laws and <br /> ordinaces yoveming lhis lype o(work will be complied wilh whelher specitiea nerein or nol The grenting of a permit does not presume <br /> �o yive authority to violate or cancel lhe provision of any olher sta�e or local law regulating construction or lhe performance of <br /> construction.That I am authorized by the owner of this properly to perform lhe work(or which applicalion is made and I comply with lhe <br /> Stale Conlractors Law 18.27 RCW and 296.200 WAC. <br /> �/�'l��/�GSl �.�5/r-NL�I�I�� Tnc. �3 200� <br /> ISi9na (0 Contractor/Authorized Agenl Date <br /> -- --- — — — i�1. <br /> � <br />