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P RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SER`,/ICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810— FFUC 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS S��"�E 11 G ppRCEL TAX I.D.8 CC575�ci.�.uTjti pERMIT# <br /> �3wc, a <br /> ;u�i � �t� a� � - � � cs�; _ ._ .�„�. (oc�- - � / <br /> LEGA LOT NO. BLOI:K TRACT <br /> DESC. � �� L�'Cr <br /> OWNER ADDRESS CITY2�y�V� PHONE <br /> i3��Z%� ts 411 <br /> . '� �l>�:�T z��. 4'3s `7 <br /> �.i:i1F�-sv -�"�2.r�c=�. Iu115 ��i� r�uc5i�. Sv �x-_ � lU <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> GZ . �il� �lc,�l ��a�,1 �t�S�. QI�Y `12S' ?_60 ' �� 5� <br /> GONTRACTOR 7=1Z�Lr�_ c�.��M�11� t v��DRESS CITY2IP PHONE _ <br /> CONTR.LICENSE J! lf��?;� L7 1�' � QL_ 1'I.�C rLC� UA ��I ZS <br /> 1�E��ci_c�-zZ��S `7�� 3 �6 -�=1 S S <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Eleclric _Gas,_Other � y SZV , v � <br /> WORF:DESCRIPTION <br /> i✓�s�1��� �h•�� �-�c.ly_ T7� �x�S i� n.�G e :-�l-c.;� +.:N +"P, <br /> �n.S,�� � (�> �� i ��.vy C—R1�, F=raN5 � 1��:1.i.�ATE ��.� E��S� � i-5��_ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling units <br /> Bathtub Forced alr systems <br /> Lavatory�wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/barlmop/etc.) � Exhausl fan <br /> BackOow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> Floor dr2in Refrigerafion <br /> Grease trap Woodsfove <br /> Roof drains Other i\,C T Wi:�iC_ <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 correct. All provisions ui law�and <br /> ordinaces governing this type of work will be compiied with whelher specified herein or nol.The granting of a pertnit does not presume <br /> lo give authority to violate or cancel lhe provislon of any olher state or local law regulating constructlon or th�e performance of <br /> construction.That I am aulhorized by the owner of this property+o perform the work for which applicafion i�made and I comply with the <br /> State Contracto�s Law 18.27 RCW and 296.200 WAC. <br /> ' � i;; ' <br /> � �,..{' �— � " U u <br /> Signature of OwnedCQntrect ut orized Agent Date <br /> , <br />