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PERMIT APPLiCAT�ON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8057—v,nvw.everettwa.org <br /> APPLICATIONS t�RE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT <br /> � ;-'? 'c' �`' � C..' Ci �' X � I G c�c'�vcu�'�c_. � /Y9 �/ O — � <br /> LEGAI LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AD�RESS CITYIZIP PHONE <br /> y7 I y ! . 1 .��, -7 � <br /> I (�� �,i i �U I ,'= ����' /!_` ! 1— Lv ' I„�"e%-f"� `.�;' �C' � <br /> TENANT NAME CONTAC�FOR PERMIT PHONE <br /> p�����' ;.,! ao�-a�ks •�taoo <br /> CONTRACTOR ADDRESS CITYIZIP PHONE <br /> 't'��2E�.lnJA� NE4`<<�.lC� �-AIG i}1n01 S l3'�-ru�t- �UK�JIIf+ �-Ufo- <br /> CONTR.LICENSE!l�J�E���,Aa�I��� Gt$ �t� a�k8 -'ZqO� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> S Fl� _Electric y/Gas_Olher � ��� � l,'v <br /> WORK DESCRIPTION - , � � i;:,;i��-+ � � f'� c��'* C��`��yl� � <br /> (_ 1�;�,i''.�� �" l � C / <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM17 NO. TYPE OF 1"IXTURE OR ITEM <br /> Teilel A/C—air handlinc�units <br /> Dalhlub ,� Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas ranye <br /> Clothes washer Clolhes dryer <br /> Laundry tray _ Range hood <br /> Sink(service/badmopletc.) Ezhaust(an <br /> Backflow preventer _ F{eat pump <br /> Urinal Unit healer <br /> Drinking Fountain Boller <br /> Floor drain Re(rigeralion <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> I hereby ceritify that I have read and examined Qiis application and know the same to be true and correct. All provisions of laws and <br /> ordinaces goveming this type o(work�+nll be complied wilh whelher specifed herein or noL The granting of a permit does not presume <br /> to give authorily to violate or cancel lhe provision of any�ther slate or local law regulating construction or the performance of <br /> conslrudion.That I am aulborized by lhe owner of Ihis properly to pedorm the aork for which applicalion is mado and I wmply with the <br /> State Cohtra� rs Law 18:27 RCW and 296.200 WAC. <br /> / <br /> //,',�;�.� �.' 'r ij�,.j�,;�� <br /> Signature of OwnedCoptractor/Aulhonzed Agent � a�6 te —'— <br /> 1 <br />