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I C,, {�j1 - - c r� 1 iG'�� <br /> PERMI� APPLICATION ---1 <br /> � CITY OF EVERETT PERI�IIT SERVICES <br /> ��j 30 3200 CEDAR STREET, EVERETT, WA 98201 `i�-(; - D� <br /> �d 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> '�� � � APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM (/� /S O(t ",3 L�' <br /> � " <br /> SITE ADDRESS � PARCEL TAX I.D.# PERMy # <br /> � .� - ,! . G < <'�3 �l-U� � OC� � ��o�r - OI l� <br /> LEGAL l0T NO. BL CK TRACT OR SUBOIVISION M 1 �` ,I � <br /> DESC. -- �l.V ',��J`— ��-\'��' `(lC � Y�"�G✓(,1��'(� <br /> OWNER �G �»f l3C � 1ylClY'ySI�QF� / c �y '3 -jL CfTY21P PFiONE <br /> .�—n��c�c�-4�V-�, .i r,v�51�����n�1-� , 1,�r ; 3kc� � y5�-E -5 i 3 t <br /> TENANT NAME CONTACT FOR P RMR PHONE�(��}SI �L"�51�I <br /> I �� eCl.�����:s�'n�-�C..� E-MAIL���G ��l Wn,SC i1 <br /> tc�L 1C �_�i.�'1"�v�` �Y1S�"1'Li.�- CT1.Ir'1C� � <br /> CONTR:�ICENSE# �J � <br /> �-,a�,�ecc<<ua.�v � �-�c:> =�cx i�c�!- �'Y— Y�S,��I '. �.1��� � ��a7u <br /> USE O UILDING �/ HEAT SOURCF CGNTRACT PRICE OF WORK <br /> � � Y� I _Eleclric �Gas_Other I <br /> WORK DESCflIPTION <br /> `��� tJe:v`: C-�`�'����"��-C'`� �� 1 /�1�iC � � % <br /> CC,�� � .�. c��. - ��`�� - G� � <br /> - � �- c: � t�J I (�' `� <br /> PLUMBING� MECHANICAL <br /> N0. TYPE OF FlXTURE OR ITEM D10. TYPE OF FI%TURE OR REM <br /> .� Toilet I I� A/C-air handling uni�s <br /> Balhtub I i I Forced air systems <br /> � Lavarory(wash basin)t! '� � Gas piping <br /> � Shower �__ Water heater <br /> _ I Kitchen sink 8 disposal � Gas fireplace <br /> � Dishwasher Gas range <br /> i Clothes washer i Clothes dryer <br /> _I Waler heater i Range hood <br /> __ Sink(service/badmop/etc.) t ,� Exhaust fan <br /> _ Backflow preventer F�eat pump <br /> _ Urinal Unit hea�er <br /> Drinking Fountain 8oiler <br /> _ Floor drain Refrigeration <br /> Grease Irap Woodstove <br /> Roof drains Other <br /> Other <br /> qTY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceritity that I have read and examined lhis application and know ihe same to be true aod correct. All provisions of laws and <br /> ordinaces governing ihis type of wurk will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authority to violate or canr,el ihe provision of any other stale or local law regulating construction or the perlormance ol <br /> construction. Tha� I am authorized by ihe owner of this property to perform the N�ork for which application is made and I comply with the <br /> State Coniractors Law 18.27 RCW and 296.200 WAC. <br /> i Signature of Owner/Contractor/Authorized AgeN Date <br /> �L i <br />