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PE�.IMIT APPLICATIO. . <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> �17i� - s�� o�� G/�s� ��°rPtl �gao 3 �- l�� - �� . <br /> LEGA LOT NO. BIOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> 51u�rt Uo��Pr �1►�- sL° m�P vJPst ��'P►�P�" �4ao3 (�as� ��R- �N6 <br /> TENANT NAME ^COIJTACT FOR PERMIT PHONE ��C�.3� �� '�(�5"Q <br /> I �7(��V� i" I � ��� � E-MAIL <br /> CONTRACTOR AO RESS <br /> PN� � ta4oS sL"� pl nlr LukrSl��wi5,� �✓� y�S-3l`i-7650 <br /> CONTR.LICENSE# 17r. I�����^DM <br /> 'Y��1 N i � <br /> USE O� BUILDlNG HEAT SOURCE CONTRACT PRICE OF WORK <br /> I l' ' <br /> �r'jiP f'ctY7t-; I ?IY�>�P �"G4yV� �/ _Electric �Gas_Other p'�rZ� 5�a„a <br /> WORK DtSCRIPTION ���,���� �O,S�'p� F�'�� '�UOINl, <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> I Toilzl _ AIC—air handling unils <br /> � Bathtub _ Forced air systems <br /> � Lavatory(wash basin) _ Gas piping <br /> _J___ Shower _ Water heater <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher _ Gasrange <br /> Clolhes washer _ Clothes dryer <br /> Water healer Range hood <br /> Sink (service/bar/mop/etc.) � C-xhaust fan <br /> Backflow preventer _ Heatpump <br /> Urinal _ Unit heater <br /> Drinking �ountain _ Boiler <br /> Floordrain _ Refrigeralion <br /> Grease irap _ Woodslove <br /> Roof drains _ Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify that I have read and examined tliis applicalion and know lhe same to be true and correct. All provisions of laws and <br /> ordinances governing lhis type of work will be complied with whether specifed herein or not.The granting of a permil does not presume <br /> to give authority lo violale or cancel ihe provision o(any olher stale or local Iaw regulating cons�ruction or lhe per(ormance of <br /> conslruction.Tiial I am authorized by the owner of this property lo perform ihe work for which application is made and I comply with the <br /> Sla�te�� jnlraclors L 27 fjCW and 296.200 WAC. <br /> ��Y--C"M,� ��7 Z N "i �' I�j- a0 I 0 <br /> ' Dale I <br /> Sig aWre oi OwnedConiraclor/Authonzed Agent <br /> � � <br />