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PERMIT APPLICATION <br /> CITY 6F EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org !� g� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 1280C? l3otj�ll-rJetett ffwy �� '.� C:C�� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION p <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> �fou�iJ..ehc.� �2800 l3atJ�ell- r�ecec� �w� FJ�tett W� g�20B <br /> TENANT NAME CONTACT FOR PERMIT PHONE 3�p (o�(� �{�l�j <br /> P�DV10.Pi��-� 112,�d,. 5toc m E•MAIL f P i as @ uartsigr��o.�om <br /> N A RUar�u�w,ec 5��n ��i5 NE HwV �ty �rt �v�r�---r�a 3bo 643 'l�� <br /> Uc.nc.ouvec i,JA <br /> CONTR.LICENSE# <br /> VRNc.oS"� ZSB 6[.. `18665 <br /> USE OF RUILDING HEAT SOURCE CONTRACT PRICE OF WORK I <br /> Me�"'�u`� _Electric _Gas_Other �") v� �' <br /> WORKDESCRIPT!ON Sjqy� 1A 5in�1e. Ya,�,C i��uri�iilC,�$C� (-hc�v��u� �F.tteCS ori I`a�Wa,u <br /> J J <br /> 3 � -tc�11 x '�1.9 � Lon,� q3� b� 5ic�h�cr <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet A/C—air handling uni�s <br /> 6alhtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas lireplace <br /> Disliwasher Gas range <br /> Clathes washer Clolhes dryer <br /> Water heater Range hood <br /> Sink(service/barlmop/etc.) Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal Unit hea�er <br /> Drinking Foun�ain Boiler <br /> Floor dra�r. Refrigeration <br /> Grease irap _ Woods�ove <br /> Roof drains Other _ <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y that I have read and examined Ihis application and know the same to be true and correcL All provisions o(laws and <br /> ordinaces governing this type of work will be complied with whether specilied herein or not.The granting of 2 permit does not presame <br /> to give authority to violate or cancel ihe provision of any other state or local law regulating construction or ihe pedormance of <br /> construclion.That I am authorized by ihe owner ol this pmperty to pedorm ihe work lor which application is made and I comply with the <br /> State Coniractors Law 18.27 RCW and 295200 WAC. <br /> Signature of OwnedContractor/Aulhorized Agen� Date <br /> ��Z <br />