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�- <br /> P�RMiT APPLICATION <br /> i CITY OF EVERETT �'ERMIT SERVICES <br /> I 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857-www.everettwa.ory <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEFTED I <br /> I <br /> I SITE AODRESS . �__ � PARCEL TAX I.D.# PER IT# <br /> ���'.<<; l�; i ';i�t w� �G���� -��Z <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CIN/::IH PHONE <br /> � ��,�'��� !jr1 J�(��i' `' �a i�}�I.i� ��C� �� J1 Ll�- I >��lti'� ��,�G��e' (Lt���l} `f1.`� Z5`) -71_`>,', <br /> �� TENANT NAME C 1{TACT FOR NERMIT PHONE <br /> ' �/c�,s ,��te% 9z�� 257- �,sfj I <br /> CONTRACTOR7� ADDRESS CITYIZIP PHONE <br /> KC!✓ SZO L /S�` i�ut �� c lic/!("C'. i'J L•'� <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PR�CE OF WOR!t <br /> _Electric _Gas_Olher � <br /> WORKDESCRIPTION �J il; . C .�S S�%�-('f z– <br /> L��c�/�'�� E�� l✓;,,�cic� d• k. ---� �>h l Cc/Y�� D-1 ,��., -�•,�vd c < <br /> < < <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NU. TYPE OF FIXTURE OR ITEM i <br /> � Toilet A/C–air handling units <br /> I _ Bathtub _ Forced air systems <br /> _ Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas freplace <br /> � Dishwasher Gasrange <br /> i _ Clolhes washer _ Clothes dryer <br /> � _ Laundry hay _ Range hood <br /> � _ Sink(servicelbar/mop/elc.) Exnaust fan <br /> BackFlow preventer _ Heat pump <br /> Urinal _ Unit heater <br /> Drinking Fountain Botler <br /> Floor drain Refrigeration <br /> I = Grease hap = Woodstove I <br /> Roof drains Other <br /> � _ Other _ <br /> I <br /> CITY OF EVERETT LOCAL SALES TAX.CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correcL All pruvisions of laws and <br /> � ordinaces gov ning this type of work will be complied with whether spedfied harein or not. The granting of a permi:does not presume <br /> . ro give auth ity to violate or ancel the provisi�n of any other state or local law regulating construction orthe perfo�mance of <br /> i constructio .�Tliat I am aut ri by the owner of this property to perform Ihe work for which application is made and I comply with the <br /> i State Co ractor� Law 1 . and 296200 WAC. j <br /> � � �'l.'�, ( � Z 1_� n L,— �I <br /> I Signa re of OwnedContractodAuthonzed Ag nt ale � <br /> � — — <br />