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( <br /> � <br /> P�RMIT APPLICATION <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 ACC�PTED FRQM 8 AM TO 4 PM <br /> SITE ADDRESS �� PARCEL TAX I.D.�/ PERMIT# <br /> �/ q ��� S� DO�1 S o 0000�Ob (��6 ' <br /> LEGAL LATNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> 1`�� b;-�l�lr'��t�Jv; [��ZS `1/L�� /�lz N�. �/Wkl�2.l./-+En(b �gn3� <br /> TENANT NAME CONTACT FOR PERMIT �- PHONE <br /> 1,.�A-;Fal'2on�,- �v�s�¢�ca�or� jp� ('.�..a2t (`}Z�j,�`l(�-Z`} 2Z.. <br /> CONTRACTOR n ADDRESS CITY2IP PHONE <br /> �Th1= �DbSon'+ l.Oµ'S-'�A�y�Lh1L. �53, rl% �(�Q�( ,57; �ELL 9aor� <br /> CONTR.UCENSE# �p 1�--3' :�D� � C� Sf C�`A C`�Zs��Z( -�33a <br /> USE OF BUILDING I — HEAT SOURCE I�CONTRACT PRICE OF WORK <br /> C�.C�LT- SS�p�,� Electric Gas Olher y �� <br /> i <br /> WORK DESCRIPTION <br /> �A��r„�� Z �•�+�i�z�ort 5 rls '�R�r � A �r�r��" <br /> I M�r�ov F_Mfcrt-�T �� O��i C� S�-�C� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF PIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathlub Forced air systems <br /> � Lavalory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Cbthes dryer <br /> � Water heater Range hood <br /> Sink(service/bar/mop/elc.) Exhaust fan <br /> BackFlow preventer Heatpump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces erning this lype of work 'I be complied with whelher specified herein or not.The granting of a permit does not presume <br /> to give au or y to violate c c'el t e rovision of any other state or local law regulating conslruction or the performance of <br /> construcC n. hat I am t o ed b t e owner of this property to pertorm lhe wor for which application is rtcade and I comply with the <br /> State Co tra ors Law 8. CW 296.200 WAC. <br /> � �2 <br /> Signature of dContractodAuthorized gent D te <br />