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— � � <br /> �- PERMIT APF'LIC�TION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—wvrN.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS ��S PARCEL TAX I.D.# PERM!T t <br /> Ihi�l, �✓e � o� �5 S6o C�oo C� a� M�(�o(�-c�l� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP q�(�j1PHONE <br /> msa. �,�ia�� i6�s i�F+ti H� �r� ��r�k�id ,�� — <br /> TENANT NAME CONTACT FOR PERMIT Pi!ONE <br /> s,n✓erl�k� p,,re��4� -�} IuG kev �for✓e, 2u4 --1G3-17N�1 <br /> CONTRACTOR��/Lr71e�/) h�C��/GI"lU ADDRESSj�'ff. ��J(M S� CITY2IPQ�/GP PHONE <br /> S15'F'j"�li 1.f�' <br /> CONTR.LICENSE k�'/�.� „ ��S�o Z ZoG-% GT 17N�I <br /> v (��i v <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> / l ODU , cu <br /> _Eleclric _Gas_Olher "� � <br /> WORK�ESCRIPTION .(Z��-r 7J-� ���I�,��-�IIr�rC�� / xhffGll �2� ��h0✓If' �✓I S• <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF F�XTURE 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 /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> Laundry lray Range hood <br /> _ Sink(service/bar/mop/elc.) _4 Exhaust fan <br /> 6ackflow preventer Heat pump <br /> Urinal Unit healer <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeretion <br /> Grease irap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify lhat I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whelher specified herein or noL The granting of a permit does not presume <br /> tn give authority lo violate or cancel the provision of any other slate or local law regulating construction or the perfurmancz of <br /> const lion.That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> Stat ontractors L 78.27 RCW and'Z96.200 WAC. <br /> b/f6 /oG <br /> Sign of Owne ntractodAuthorized Agent Date <br /> �'P�l�J� �� <br />