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PtRMIT APPLICATI(�N <br />CITY OF EVEF2ETT PERA7IT SERVICES <br />3200 CEDF,R STREET, EVEFETT, WA 98201 <br />425-257-8810 - FAX 425-257-t3857 - wwv�.everettwa.org <br />APPLICATION:; ARE ACCEPTED FROM 8 AM TO 4 PM <br />� <br />I'�,� • '/,; -!'i'�,_ <br />SITE ADDRESS PARCEL TAX I.D. p � PERM� # <br />�(c,3G ���� �(_�L __� Z�Gs��%OO�oI�S'<.OI��`���''G,cl. <br />LEGAL LO N� � BLOCK� TRAC , <br />IJI:�C. �� �j � j ���j Z —O � <br />OWNER AODRESS CITV2IP PHONE y 7_ �� - <br />�'i���l�Cv� ��UIIY � ���U� �� lr> ,�T'�h1cH �If�Zrlv �3C 0`14� <br />TENANT NAME CONTAC7 FOR PERM1IIT PMONE <br />: �( ' <br />CONTRACTOR <br />J�l��,�,��� �, I�t,�,��� <br />�CQ TR. LICENSE p <br />►1c�,, ,�< <,� � ---J1 _ir � <br />USE OF BUILOING I <br />, }7 � <br />------ � <br />WORK DESCRIPTION <br />ADDRESS <br />'" '�r .,t <br />�� <br />HEATSOURCE <br />Elnctric Gais Other <br />�> � �_ �>< <, ���1 1 � �> <br />PLUMBING —I <br />NO. I TVPE Of FIXTURE OR IiEM <br />,� Todal ' <br />�F3alhtub <br />L:rvatury (wash b. sin) , � <br />��-- Shawor ! ' <br />`�`- <br />. / _ Kdchr.n sink 8 disposal <br />i Dishwashr.r <br />7 Clolhos wash�r <br />_ !_ W�tler hualer <br />Sink (sr.rvicolharhnaplMc J i <br />-- l3ackllnw prevenlor <br />Urinal <br />Drinkiny Poimtain <br />Flonr drain <br />GfP.05B �f8�1 <br />Fi00� (�f:11f1S <br />Olhor <br />CITY2IP PHONE L-{7 -S - <br />��`�1��U '>>x� - C�4U�� <br />CONTRACT PRICE C� WORK <br />NO. I TYPE OF FIXTURE OR ITEM <br />NC - air handling wiits <br />Forcad �ir systems <br />Gas pipinc� <br />Wnter heater <br />Gas lireplace <br />Gas ranc�e <br />_J_ Cb�hes dryer <br />�_ Ranqe houd . / r <br />� Exhausl fan <br />_ . Hcal pump <br />Unit healer <br />�oller � <br />Relrige�ation <br />Woodstove <br />CITY OF EVERETT LOCAL SALES TAX CODE IS �705 <br />I herehy ceri6l�- Ihal I haw� read enA ex�mineA lhis �ppllcatiun and know thr, same �o be irue anA correcl. All provisions ol laws and <br />ordinacr.s governmy this type of work will be complied wilh wholhor sp�cified horein or noL The gr�nlinc7 of a permil does nol presume <br />to give authorily lo violate or cancel the provision ol �ny olher slate or local law regulating conslruclion or tha peAormance of <br />conslrurtion. Thal I am �vithorized by the owner ol lhis properly to perlorm Ihe work lor which applicalion Is matle and I comply wllh ihe <br />S�ale Contm��Aurs Low+in27 RC and 29F20P WAC. <br />�.� ���;< .c� � I.� 4- o s <br />