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I <br /> P�RMIT APPLICATI(�dV <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810— FAX 425•257-8857—www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDF<ESS PARCEL TAX I.D.# PERMIT#� <br /> ! ��'{ �f I I�/-1. L (�' l� l t7 � �' O O 0 I 6 n � ��6 � �� I'I <br /> LEGAL LOTNG. BLOCK TRACT '� <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> [�CIrA�?DIN fJcVe.Lupme.Nt- S/�toHom�SN � iA qj'' 7a <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> K��,s lus r�F��._z J�c.�ay [7ac.zi�i._ �fJS��`f�'SS�tI _ <br /> CONTRACTOR ADDRESS CITYIZIP PHONE <br /> (j[�i7'7�7ic_ MuK�viCAL�K- =i�fJ- Gc'rnAVE•W. d-o7� �'ITLk- le�•AG��C✓/�. [-(�'S-7)�j--�d�f� <br /> CONTR.LICENSE# C��pc}�� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Eleclric �Gas_Olher �S'p� °y <br /> ()l=�iGr' — 4 <br /> WORKDESCRIPTION ,�('J/J �t SurP�y /�U/J� �?cLvG�f� I Su/�F'�-`� <br /> PLUMBING MECHANICAL <br /> Np, TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Balhlub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kilchen sink 8 disposal _ Gas fireplace <br /> Dishwastier Gas range <br /> Clothes washer _ Clothes dryer <br /> Laundry lray _ Range hood <br /> Sink (service/bar/mop/elc.) _ Exhaust fan <br /> Back(low preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinkin� Founfain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roof dreins Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I have read and examined lhis application and know lhe same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied wilh whether specified herein or not.The granling of a permit does not presume <br /> to give authority to violale or cancel the provision of any other stale or local Iaw regula6ng construclion or the performance of <br /> conslruclion.That I am authorized by the owner of this properly to perfor�n the work for which application is made and I comply wilh the <br /> Sta onlractors Law 1827 RCW and 296.200 WAC. <br /> /,�.t� l^ r�/� DG <br /> Sig atur f wner/ ontraclorlAuthorized Agent Date <br /> r <br />