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� cRMIT APPLICATI.�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-881 C�— FAX 425-257-8857 —wv�nv.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 3bat -a��� s;. � OoS16858�00�00 ' - Z <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC.� <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> �i��wra �zu.illen 36�-1 ��E'�5 St Cur�nc-'t+ 4as-aca— ly46 <br /> TENANTNAME CONTACTFORPERMIT PHJNE i�zy_-j5,� _����� <br /> %.,aa E-MAIL <br /> �GNTRACTOR ADDRE S CITYIZIP P yas-7s-�t-b�o3 <br /> TG. f�c'oPc2 G..--Ns�RuC-rrchf � Snc. 761- Ha.w'it.�.r.,� I.N. Cwu..Ku Tsl. <br /> CONTR.LICENSE# / � <br /> '�'C��C�O c.'Z �i-Zb C S Z/�`� yfi�$oL <br /> � <br /> USE OF BUILDING /��� HEAT SOURCE CONTRACT PRICE OF WORK <br /> S � r� f Electric _Gas_Other �t�,�'c�9 �� <br /> WORK DESCRIPTI N ��cR« — <br /> sZ R.oKbh� _ w.a.a�� ax�:+r...� �,��-# dryU i�. �r•xsd-n.� <br /> �c.rk.a� . US11.� an cin.� oG G.�.•K,�,L„ ,C�„�- w .a.wsfcr b._'}4� r1�-F 'Fl.c k1�c(L bedlw.. � <br /> �"f"'�- - C7ffE:ticR = 2k-�'c..dl,� -�l.e_ c.Nu.•� Purck nre.. 6y t3` � C_�5� ekts`��d� 5(;Jr. -F,; 4 <br /> S` Fre.».(� � �:� « b°4` w�.. uw �-o e',c:s,-• � e.�...�: RK� r <br /> PLUMBIN MEC NICA <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toile� A/C-air handling unils <br /> Bathtub Forced air systems <br /> � Lavatory(wash basin) Gas piping <br /> I Shower N/ater heater <br /> Kilchen sink 8 disposal Gas(ireptace <br /> Dishwasher Gas range <br /> � Clothes washer Glolhes dryer <br /> 1 Water heater Range hood <br /> Sink(service/bar/mop/elc.) � Exhaust fan <br /> Backllow preventer Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Re(rigeralion <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Olher <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS?705 <br /> I hereby ceritify lhat I have read and examined lhis applicalion and know lhe same to be lrue and correcl. All provisions of laws and <br /> ordinaces c�oveming Ihis typc of work will be complied wilh whether specified herein or not The granting of a permit does not presume <br /> to give aulhorily to violate or cancel lhe provision of any olher stale or local law regulatiry conslruction or the pertormance o( <br /> construction.That I am authorized by lhe o�mer o(lhis property to pertorm the work(or which application is made and I comply with lhe <br /> Stale Cunlraclors Law 18.27 RCW and 29�.200 WAC. <br /> -',�,G�( � .Y ,, �%s,�..� «�i3��8 <br /> SignaWre o(OwnedContra or/Authorized Agent Da e � <br /> /�� <br />