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i <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVFRETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br /> I SITE ADDRESS �I U - I�I � � �� PARCEL TAX I.D.# I pERM1T# I <br /> � L�ri� �tR i � � �'o5ia <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER Jl(�w+�e�r7'y{ '> qD�RE55 CITY2IP PHONE <br /> L�v1N� ��CYtV1 <br /> Cb�1S�-i SEQH�F l�b ��� /��I� y��-(�, ��vt �n.��a �i �� 0 � <br /> TENANT NA CONTACT FOR PERMIT PHONE <br /> GUjN i 1 �tcu.� S���l �;�N i �r�� % �:z-ul 7 i�( - 7 S9-U, <br /> CONTRACTOR ADDR�55 CITY2IP PHONE <br /> I ���iflK �l��ut-rEil�1C�� c� NECFIAN�cfl�- i`I�� 17�� iauF �. La��L �71�� - ��`1-l0 <br /> CONTR.LICENSE# <br /> ��if1Rj'��� A- �;l�!-t.ibv 5� ,:,1-1��, ��.� ��n,lq4- <br /> USE OF BUILDING — HEAT SOURCE I CONTRACT PRICE OF WORK I <br /> ,.Z .� G'�il <br /> Electric Gas Other /� �� L" <br /> WORK DESCRIPTION <br /> �I I `T��,'i i�l�i I��C-• h,;l- w �� IK j Ui�l- tl��I� '. i��� . <br /> PLUMBING MECHANICAL <br /> NO. 7YPE OF FIX'URE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> Bathiub Forced air systems <br /> I � Lavarory(wash basin) _ Gas piping <br /> Showe� Water heater <br /> I _ Kitchen sink 8 disposal _ Gas freplace <br /> Dishwasher Gasrange <br /> I _(_ Clothes washer Clolhes dryer <br /> Laundry tray Range hood <br /> i = Sink(service/bar/mop/etc) = Exhaust fan <br /> BacMlow preventer Heat pump <br /> � . Urinal Unit heater <br /> � Drmking Fountain _ Boiler <br /> � _ Floor dram Re!rigeration <br /> _ Grease trap Woodstove <br /> Roof drains Otlier <br /> � Other h Ii,�;S<<.� <�('f� <br /> i � S�Cr,(� .�.�,,.I., �f�..7�, _ <br /> I CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby centify that I have read antl ezamined this application and know the same to be true and correct. All provisions of laws and <br /> � ordi�aces goveming this type of work will be complied vnth whether specified herein or not The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construction or ihe performance of <br /> construction. That I am au�horized by the owner of this property to perform the vrork for which application is made and I comply with the <br /> • State Contractors Law 1827 RCW and 296.200 WAC. <br /> v"�.-,,. ...__: r' ;: � /�' / S t^�-- <br /> I� Signawre of OwnedContractor/Authonzed Agent DatA <br />