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P�RMIT APPLICATf(�N <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.# P RMIT# <br /> Z.`It��� r� Si c�43Fr7 •-2z� _W; -cx: �Q'� <br /> LEGAI LOTNO. BLOCK TRACT <br /> oesc. 3 ,� � S zz[� Oc/+�� — �'ii�r�;'TT "T'' ✓o� "1 /Jc� 30 <br /> OWNER ADDRESS CITY2IP PH NE ytS- <br /> TS� 0- C.�lR7rr� � �.c. Po . ,g�x ��� L-�9i�cSr�cnS �tn�� S�zs� ssc��� 7 <br /> TENANT NAME CONTACT FOR PERMIT PHONc' <br /> .ST�v� Wra,�=�S�J '/Lr-3se--��G 7 <br /> CONTRACTOR ���`�rt, ADORESS CITY2IP PHONE <br /> l�o�.rr,l Tr�*- /�u, gc;�r f3�18 �J2s ,s�S'G •77G7 <br /> CONTRLICENSE# L,�- ,�C?/"c/1S Wf� 9SZS� <br /> ��kE�Hr oor J'L � <br /> USE OF BUILDWG HEAT SI�URCE CONTRACT PRICE OF WORK <br /> .t7.:1'L 1,7C I _Elactric �Gas_Other <br /> WORK DESCRIPTION <br /> COr9ST/�uG7/W�' 0l= l4 -/.��'L(:)C <br /> PLUMBING M[CHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITFM <br /> Gi Toilet A!C—air handling units <br /> � 8. Balhlub Z Forced air syslems <br /> _,�__ Lavatory(wash basin) ' � Gas piping <br /> Shower Z- Waterhealer ' <br /> 'Z_ Kitchen sink&disposal Gas fireplace <br /> 2_ Dishwasher L Gas ranne <br /> Z Clolhes washer Z- Clolhes dryer " <br /> Z_ Waler healer Z. Ranc�e hood <br /> Sink(service/bar/mop/etc.) � Exhaust fan ' <br /> �ackflow prevenler Heal pump <br /> Urinal Unil healer <br /> Drinking Fountain Boiler <br /> Fluor drain _ Re(rigeration <br /> Grease trap Woodslove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS J105 I <br /> I hereby cerilify that I have read and examined this applicalion and kr,ow the same to be true and correct. All provisions of laws and <br /> ordinaces governing this lype of work will be complied wilh whelher specifed herein or not.The granling of a permit does nol presume <br /> to give aulhority to violate or cancel lhe provision of any other siale or local Iaw regulating conslruction or the periormance of <br /> construction.That I am authorized by ihe owner o(this property to perform lhe work for which applicalion is made and I comply with ihe <br /> State ConVactors Law 16.27 RCW anQd 296.200 WAC. <br /> ��i/A � �e���� li <br /> Signalure of OwnedContractor/Authorize nt Date II <br /> ��'a <br />