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�ERMIT APPLICATIUN <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 � � „C.� ,�9' <br /> SITE ADDRESS PARCEL TAX I.D.# P/[ERMIT# <br /> �>S1C . zj Si' , cc:S� bb= •- S3Y- c3o - cf U /d � l�/(v <br /> LEGHL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. yu , �i I . }' " s�i y <br /> OWNER ADDRESS CITY/ZIP PH�IE�� 3 <br /> I/_i>cl_ �� M i i[f�ic.<.t_ � S. r� � Z1 $-7- � vt�a-c.�97 `IaS � � 7� <br /> TENANT NAME CONTAC'f FOR PERMIT PHONE Z U�.j u,j-/) � � <br /> -.�L—f-/C �lz.e:e�/G } E•MAIL �}'2�7olGSJ Cw�.✓O6• U '. <br /> CONTRACTOR AD RES ITYI <br /> /11� I('�;vy:�� [/P ���.� 51 i''j n�� 11 Crr,-. 2oh-3�u- i .5 �� <br /> CONTR.LICENSE# <br /> �/�> R�� nK�i �x98 � -1 '3._ 2�n,-,ur.,.1 `i8nS�j <br /> US�fOF BUILDING I — HEAT SOURCt I �O�AC7 PRICE OF WORK <br /> i �;, ,1 i,,,��; i;:- Electric �' Gas Other Z V L�-1 <br /> WORK DESCRIPTION I <br /> � ,���� •,�y ���_��.. .\c_.� ,�:c' � { J�;��.r� rc,r. ( �^ F Uvp ,+ni:_(l 52�-!3•,�t�.�J , . <br /> �.,i-._ , i e_O J tr1 ^...� (.J 1^✓(h��.,J �Ll���l.��-(_ f1,91'N I. ..j � N'��.�(�i..l J�l... 1�../� l4 /3�L Zf}'ll i� � <br /> 5:�� � � A��,:.ks. <br /> PLUMBING MECHANICAL . <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTllRE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air syslems <br /> Lavatory(wash basin) Gas piping <br /> Shower Waler heater <br /> Kilchen sink&disposal Gas fireplace <br /> Di�+asher Gas range <br /> ClotheS asher lothes dryer <br /> _ Water hea R e hood � <br /> Sink (service/�ad�nop/elc.) Exha t fan ' <br /> Backflow prevenler Heat pu <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeralion <br /> Grease lrap Woodstove <br /> Roo(drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ce�ility thal I have read and examined lhis applicalion and know lhe same lo be true and correcl. All provisions of laws and <br /> ordinaces governing this lype of work will be complied with whelher specified herein ur nol.The granling ot a permil does not presume <br /> �o give authorily lo violale or cancel the provision of any other stale or local law regulating consWctlon or the peAormance of <br /> construclion. i hat I am authorized by the owner of this property�o perform the work(or which application is made and I comply wilh the <br /> State Conlraclors Law 16.27 RCW and 296.200 WAC. <br /> � _..1 � l.. . �. �o,,� c• °t <br /> Sig�aty e o(OwnedConiractor/Authorized Agent Date � <br /> / Z <br />