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PL�tMIT APPLIC�TIC�: <br /> CITY OF EVERETT P�RMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 ///jjj I <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org ��/�l_/yy <br /> (J ��`��T <br /> APPLICATIONS ARE ACCEPTED FROM S AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE A�DRESS � PARCEL TAX I.D.# PFZRMIT# � <br /> 1 I� �� i�C� ,vP � � �'evk 0 vas� S�do oo/ o� �r v i `1 / <br /> LEGAL LOT NO. BLOCK TRACT ' <br /> DESC. <br /> OWNER ADDRESS CI1Y21P rHONE <br /> n � I, , � t � 1' U� •1✓��`l'��3 <br /> TENANT NAME � . • CONTACT FQREERMII'-_--..__. ._ . _ __pHONE�-!_--.�_.�_.. `. <br /> �'i IV�'„�� 1,�l,K-� I'1110�'Q,�'�. " <br /> � � � ��� ov r,u�� m�U ��li�6,a G�� C[�Llrit�uU �� � U2��� �:��� ►� � <br /> CON'iRACTOR ADDRE55 . CITY2IP PHONE ' <br /> _ ..._._..._.._. - <br /> ��-inc� 1��� dS <br /> CONTR.LICENSE# � <br /> ��'11'�� � � <br /> USE OF BUILDI G HEAT SOURCE I CONTRACT PRICE OF WORK <br /> L�c+r�m�r��,ct r I <br /> ( ��n\��� �1 u,Y� l _Electric �Gas__Other <br /> ✓ <br /> WORK DESCRIPTION <br /> 5�E ��ik'n�5 <br /> PLUMBING MEGFiANICAL <br /> NO. � TYPE OF FIXTURE OR ITEM N0. TYpE OF FIXTURE OR ITEM <br /> � Toilet _ A/C—air handling units <br /> Bathtub Forced air systems <br /> _[_ Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> _ Kitchen sink 8 disposal Gas fireplace <br /> _ Dishwasher Gas range <br /> Cbthes washer Clothes dryer <br /> _ Laundry tray '�' �L I�-�1 Range hood <br /> _ Sink(service/bar/mop/etc.) Sj! � � Exhaust fan <br /> _ Backilow preventer Heat pump <br /> i = Urinal = Unit heater <br /> Grinking Fountain 8oiler <br /> Floor drain Rdirigeration <br /> _ Grease trap Woodstove <br /> _ Roof draine � Other <br /> Other — <br /> 1 <br /> CITY OF EVERE7T LOCAL SALES SAX CODF IS 3105 <br /> I hereby ceritiP�thal I have read and esamined this application and knew the same to be true and corre�t. All provi�ions of laws and <br /> ordinaces governing this type of work�vill be complied wilh whether specified herein or not.The granting of a permit does not presuma <br /> to give authority to violate or cancel the provision of any other sta!e or local law regulating construction or the performance of <br /> construct�on.That I am authorized by the o�yn�r of this property to perform the work for which application is made 2nd I comply with the <br /> i State Contract9rs Law 18.27 RCVt' and 296.200 WAC. <br /> � ,�, � �. / , � . �/Z � o <br /> , _ ,� <br /> Signatur8 of 0 nedContractoCAuthorized A nt Date � �2 <br /> � <br /> � <br />