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PERMIT APPLICATI�N � <br /> I CITY OF EVERETT PERMIT SERVICES � <br /> 3200 CEDAR STREET, EVERETT, VVA 98201 I <br /> 425-257-d810 — FAX 425-257-8857 —www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 72C�1 J'v�� � � JE i�a�sC7� -015 <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER A�DRESS CITYIZIP PHONE <br /> � „���f �" /?'�� )�:✓ <br /> _�; - !�, n.: R . �a��l�l-�� 4��i /a�"�y�5c ✓vrC�-� `�d2��C�)3�� =>09� <br /> TENANT NAME CONTACT FOR PERMIT PHON��-Zj �"�p � y�]7 c7 <br /> L��t G� � � G .�j/ E-MAIL 2���OPQi�+J Q�. 7n <br /> CONTRACTOR AD ESS CITYIZIP �[jNE �— <br /> �9-� � �� �- u��. �/s <br /> CONTR.LICENSE# � �p•�� <br /> �a -��- o �� <br /> USE OF BUILDING HEAT SOURC� CONTRACT PRICE OF WORK <br /> '9 � Electriry/ Gas_Olher �c�-�C��. o cJ I <br /> � �� ' � �� 4=. <br /> WORK DESCRIPTION ,�/ �� / <br /> �c':iS-{r����JG� F���Ct� �^Cc� I^r�TGlii'i/l� Ll�ll�� ��J Y��QC� �7�i,S7 1^� 1�✓' -i� <br /> �'�Fv�i�in f �:t,'9/r� -f��u� ��ny ���i���i�;a"�e�l. <br /> PLUMBING MECHANICAL <br /> Np, TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ AlC-air handling units <br /> BalhWb _ Forcedairsyslems <br /> Lavatory(wash basin) _ Gas pipina <br /> Shower _ Waterheater <br /> Kilchen sink�disposal _ Gas(ireplace <br /> Dish�vasher _ Gas range <br /> Clothes washer _ Clolhes dryer <br /> Water heater _ Ranae hood <br /> Sink(service/bar/mop/etc.) _ Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal _ Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain _ Re(rigeralion <br /> Grease lrap _ Woodslove <br /> Roo(drains _ Other <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 li <br /> I <br /> I here6y ceritify that I have raad and sxamined this applicatien and know the same to be true and correct. All provisions of laws and <br /> ordinaces�overning lhis type of work�vill be complied wilh w . .Iher specified herein or noi.The granting of a permit does not presume <br /> to yive aulhority to violale or cancel lhe provision of any olher state or local law regulatin� conslruction or the per(ormance of <br /> construction.That I am autherized by lhe o�vner of this property to periorm the work tor�vhich application is made and I comply with Ihe <br /> Stale Contractors Law 1&.z7 RCVJ and 296.200 WAC. <br /> 1'� �// 1 i1!�r ,,�,� � "I /LG.G�'0 <br /> Sjq �l �r o; w r�� on a odAulY�orized Agent ' Dale ' <br /> �� <br />