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PE�RMIT APPLICATIO�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAZ STREET, EVERETT, WA 98201 <br /> 425-25?-8810- FAX 425-257-8857-www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> I`-E I ��'f1VLr $�f. O 7 O D ZJ� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. p � <br /> OWNER A'JDRESS CITY2IP PHONE <br /> LI�A�PiNc.� SQUARc.r .iNl/��lrk�vl�s �J• �OX' / 059 CNoHomic�,�9ka-9i <br /> TENANT NAME CONTACT FOR PERMI? PHONE <br /> FY/lNJLIG.PhJ FOJD � SmoCe_ Sf-l0� ��Y OALZIL�7- y15^"1�4-$S�t� <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> ac.yr�a,o�c Mu.araukq� rNc �i� �y G6"�AU�', w. su�r�,�-���* H�Tc�.t�uti3 �i5-�'f-��l <br /> CONTR.LICENSE i! <br /> _ c�c.;/rnpmTi�vol <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �`�.-�p�L _Electric �,Gas_Other I �$ �D ' <br /> WORKDESCRIPTION ���Z� /_ 3Tvn� /Zp:�To� Icp����yTielG NYf7� .Ltih•CZ <br /> ,G�'�'l 3 �uPP�a�s� / 2c.'7 r.U21v �t/R� SAS P�l�uG l o �/) Frl�u�cl l ,��/'�z.�oin <br /> �y,crv-�u�-r,�,y, <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OP FIXTURE OR ITEM <br /> Toilet _� A/C—air handling unils <br /> _ Bathtub Forcedairsystems <br /> _ Lavatory(wash basin) _L Gas piping <br /> Shower Waler heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gasrange <br /> _ Ciothes washer Clothes dryer <br /> _ Laundry tray Range hood <br /> _ Sink (service/bar/mop/etc.) _L Exhaust fan <br /> _ Backflow preventer Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeratior, <br /> Grease trap Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> I hereby ceriti(y that I have read and examined this applicalion and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or not.The granGng of a permit does not presume <br /> to give authority to violale or cancel the provision of any other state or local law regulating construction or the performance of <br /> construction.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 /> St Contractors Law 1827 RCW and 296.200 WAC. <br /> =�<—P /D /i a � <br /> a ure wnedContr todAuthonzed Agent a�e �/� <br />