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PtRMIT APPLICATI��V <br /> CITY OF EVERETT PERMIT SERVlCES (p� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 n, \f� ' <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org �/�,t) <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D. # PERMIT# <br /> L/s s �r_ c aso -OCo <br /> LEGAL LOTNO. BLOCK TRA/C3 // /J <br /> DESC. s �—C��-v�-'-P'''.�:� <br /> OWNER �� ADDRE55 J- CITY2IP PHONE <br /> .�'4p /�.�%�G�.l �-�� ,�'/ov'� yic <�'� . ys�� �Eo3 �i-�6�i <br /> TENANT NAME �I CONTACT FOR PERMIT PHONE I <br /> CQ�JTRACTOR ADDRESS CITY2IP PHONF. <br />, /�C' /�'w,�Gz�1.0 � �C <br /> CONTR.LICENSE# <br /> � " ..� <br /> r��'���� D Z ��3 � D���'Y/c-� �.L�/,��,, yc-�3< l�o�yi�Cav <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ���� ��,�,,��( �� x���� � _.Electnc �Gas_Other ��'f-����� <br /> WORK DESCRIPTION � � --� <br /> ��,>�.�:�L�:�f -�� n--�-�-� r�,=.J %. �- 3 <br /> PLUMBING MECHANICAL <br /> MO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM � <br /> _� Toilet A/C—air handling units � <br /> � Batfrtub � Forced air systems <br /> � Lavatory(wash basin) Gas i in <br /> Shower P P 9 <br /> Water heater <br /> � Kitchen sink& disposal � Gas fireplace <br /> � Dishwasher / Gas range <br /> T Clothes washer I Clothes d er <br /> _ !aundry tray Range ho d <br /> _ Sink (serviceibar/mop/etc.) ,�'f Exhaust fan <br /> � Backflow p�eventer Heat pump <br /> _ Urinal Unit heater <br /> Drinking Fount2in Boiler <br /> _L Floor drain Refrigeration <br /> __ Grease trap Woodstove <br /> _ Roof drains Other <br /> Other — <br /> I <br /> CITY OF EVERETT LOCAL SALES TAX CCDE IS J105 I <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces goveming this type of work will be complied wilh whether specified herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> ccnstruction.That I am authorized by Ihe owner of this property to perform the work for which application is maGe and � comply with the <br /> State Con�r�ctors Law 18.27RC'iJ and 296.200 WAC. <br /> i ? �!��� �'� y .27-os' <br /> Si ature of Own nContractoY/Authonzed Agent pate � <br /> 2 <br />