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P��MIT APPLICATIG�J �X 3��G��� <br /> CITY OF EVERETT PERMIT SERVICES ��73 � <br /> 3200 CEDAR STREET, EVERETT, WA 98201 g rl �j�' <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.or ` �J� <br /> � <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTEC� <br /> SITE ADDRESS PARCEL TAX I.D.# pERMIT ii <br /> ('��r s S .. . 31Z.�I�S 300 E.00 ��J�'/�—�� <br /> IEGA LOTNO. BLOCK TRACT <br /> DESC. C�JYf�f�C y <br /> OWNER ADDRESS CITYIZIP PHONE <br /> I��aN�Rkc,� ,�- [� c, po /3ox9ia C�r�vrov ��8;�3N 3�a-3y/- ylv�/ <br /> TENANT NAME I CONTR:.T FOR PERMIT PHONE <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE <br /> R�D l��R,y-c�Ffir < < c P, o,��x9io c�i,vrov, yf��3G 3e��3v�- �/GoY <br /> CONTR.LICENSE# .� ( .�/���� <br /> 1'�iRl�c �.� Diz�g i ' / <br /> USE OF BUILDING HEAT SOURCE CONTRAC7 PRICE OF WORK <br /> S%.UG LF FA�7 iL f fj tcrf'L L/,+,�[- I _Eleclric �C Gas_Other I y 5/ Ov O <br /> WORK DESCRIPTION ' <br /> � <br /> �- �i <br /> Co.USTipl�GT� ll��cv SI•UGLF F/��1iL DWf',!L .VG <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIX7URE OR ITEM <br /> � Toilet A/C–air handling units <br /> � Bathtub � Forced air systems <br /> � Lavatory(wash basin) �_ Gas piping <br /> Shower �_ Water heater <br /> � Kitchen sink 8 disposal 1_ Gas fire�:ace <br /> � Dishwasher / Gasrange <br /> � Ciothes washer % Clothes dryer <br /> _ Laundry try _L Range hood <br /> _ Sink(service/badmop/etc.) � Exhaust fan <br /> _ Backilow preventer Heat pump <br /> _ Urinal Unit heater <br /> Drir.king Founlain Boiler <br /> � Floordrain Refrigeration <br /> _ Grease trap Woodstove <br /> __ Roof drains Other <br /> = Olher_ _ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceritify that I have read and examined this applicalion and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of wor4 will be complied with whether specified herein or nol. The granting of a permit does not presume <br /> to give authority to violale or cancel the provision o(any other stale or local law regulating construclion or the performance of <br /> construction.That I am authurized by the owner of this property to perform the work for which application is made and I comply with lhe <br /> State Contractors Law 19.27 RCW and 296.200 WAC. <br /> �i,n.i=y �' (�"'"' S�-:7J-oS <br /> Sign�mre o�,vwnen�ontractor/Authonzed Agent Date `Iy <br />