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PErtMIT APPLICATI�id <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 96201 <br /> 425-257-8810— FAX 425-257-8357—www.everettwa.org <br /> 0 �v �-/09 -�s <br /> APPLICATIONS ARE � CCEPi'ED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS � PARCEL TAX I.D. # ERMIT# <br /> D � �/',..�,�._ �i 9os 3/ 00.� � 3� 0 �, � C�bCj -.�2 <br /> LEGAL LOTNO.� BLOCK TRACT �� <br /> DESC. <br /> OWNER ADDRESS CIN21P PHONE <br /> �¢D �'.at-�.�' C� � � C f'/2as 9�io 'C�w� , W a - ,�s�T� <br /> TENANT NAME CONTACT FOR P6�MiT PH NE <br /> I /-J � �r�� 7 �S – -Z ,7 S - .-�1�z 2 I� I <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# <br /> C7 c�� �(/F �' <br /> USE OF BUIL�ING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �� �L��' Electric �Gas Other �� U C G <br /> WORK DESCRIPTION � <br /> � -� � �� �. �° �/ <br /> C���-��� � .S� - � .��� . u.zC�.�, . <br /> PLU ING MECHANICAL <br /> I� N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM I <br /> Z Toilet A/C–airhandling �nits <br /> �1. Bathtub / Forced airsystems <br /> J Lavatory(wash basin) JT Gas piping <br /> 2� Shower / Waterheater <br /> �_ Kitchen sink 8 disposal 1 Gas fireplace <br /> L Cishwasher / Gas renge <br /> I L Clothes washer 1 Clothes dryer <br /> Laundry tray z Range hood <br /> __ Sink(service/bar/mop/etc.) 9;� Exhaust fan <br /> Backilow preventer Heat pump <br /> � Urinal Unit heater <br /> Drinking Fountain Boiler <br /> _ Floor drain Refrigeration <br /> Grease trap Woodstove <br /> �i Roof drains Other <br /> Other — <br />� CITY OF EVERETT LOCAL SALES TAX CODE IS 3;D5 <br />` I I i�ereby ceritify that I have read and examined this application and know the san�a to be hue and correct. All provisiens of laws and <br /> ordinaces goveming this t.:oe of work will be complied wilh whether specified herein or noL The granting of a permit does not presume <br /> Ito give authority to v�olate o� cancel the provi;ion of any other state or local law regulatiny construction or the performance of <br /> construction.That I am auihorizcd by the owner of this property to per(orm the work for which application is made and I comply with the <br /> State C � tors Law 18.27 W and 296.200 WAC. <br /> ��� � -� ?��i y- z� - �� � <br /> i <br /> Signature of Owneri ontractodAuthcrized g Date <br /> I S '� �I a�' <br />� ___ _ <br />