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i <br /> PERMIT 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 ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# I PERMI�T <br /> 1I01U f ��t" �U� S�- 1�' o� - � o <br /> LEGAL LOT NO. BLOCK TRACT OFl SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE y Z �` '`52 <br /> ��a�I�d'c� V-�e�4�'`�. �o �vX 5210�- �vf,t'�tt, w�t 5 yU0 <br /> TENANTNAME CONTACTFORPERMIT PHON 3(oO ���y (�'� l <br /> 2 I ��u/Y ��� E`� SS T'GY'C./I / �K- E.MAIL <br /> CONTRACTOR Iiv01 ..Lo,/1IU41�} �//7c'. �{�jC ADDRESS���3Z� � G S.f S� CITY2IP PHONE 3GD � ��) <br /> F � 83 <br /> CONTR.LICENSE# `.,�D 1 ( . �#��m��� (v(,t � a � �/ .�- <br /> ��1 c Pl 0 33c.7 �o / <br /> USE OF BUILDING HEAT SOURCE CON�RACT PRICE OF WORK <br /> '1 � ` j�r :,; ��Ll � _Eleciric __Gas_Other / � ��� � <br /> WORKDESCRIPTION.-rr'•:,�fnl/ � (���;�t (7�,,,��l�or� �D6/ G�t!{'/rr d� ' OI�G!-�/o3uS• <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITElA NO. TYPE OF FI%TURE OR ITEM <br /> Toilet _ A/C-air handling units <br /> .__ Bathtub _ Forced air systems <br /> ___ Lavatory(wash basin) Gas piping <br /> Shower W aler heater <br /> Kitchen sink &disposal _� Gas lireplace <br /> Dishwasher _ Gas range <br /> � Clothes washcr ____ Clmhes dryer <br /> __.� Waler healcr Range hood <br /> _ _ Sink(servicelbadrciop/etc.) _ Exhaus�lan <br /> __ Backfbw preventer __ Flea�pump <br /> Urinal Unii heater <br /> � _ Drinking Fountain aoiler <br /> Ploor dr2in � � Refrigeralion <br /> Grease irap �� �'�� � Othedstove <br /> �__ Roof drains _ _ ______ <br /> Othrr <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> I hereby ceri�ily ihat I have read and examined�his applica�ion and know lhe same to be true and correcl. All provisions of laws and <br /> ordinaces governinc�ihis type o(work�vill be complied�vith whether,pecified herein or noL The granting of a permit does not presume <br /> to give authority ro violate�o cancel�he provision ol any other state or local law regulating construction or ihe pedormance of <br /> consiruc�ion.That I am a,�l'qYized by ihe owner o(ihis property to per(orm the work for which appiication is made and I compiy with iha <br /> Statc CoNractors Law 1¢.2.Y RCW and 296.200 W�C. <br /> l`; - --r- �'--�_-:_._...�. �-i 8 -v g <br /> SignaWre of OwnedCo trectadAuthorized Ac�ent Date <br /> �— <br /> �I <br />