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P..RMIT APPLICATIG,J <br />CITY OF EVERETT PERMIT SERVICES <br />! 3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8910 - FAX 425-257-8857 - www.e;eretlwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br />' SITE ADDRESS PARCEL TAX I.D. � PERMIT p <br />�� <br />-� ��_—lL� __.� S L�' �'C�s3Jy-Ov�'�'y' d � CoS�=C?.�— <br />' L[G4L LOTNO. BLOCN TRACT ( <br />UESC. .r� � � . . <br />_�_ar��ro� J{Y __ �;_' , . r ,� � � c� � <br />� OWNER ADDRESS ^ITY/ZIP PHONE <br />� �/LlJ1'f'y /(��IcS ?n�_ �.Ci di�/5 �,C' %LJ-1�. 2'-�6�Y� <br />'i TENANTNAME � � I CONTACTFORAERMIT PHONE <br />� CONTRACTOR <br />1,1�lr�4-S�,`�� <br />CONTR. L�ICENSE p � <br />USE OF <br />S %- �l <br />WORK DESCRIPTION <br />� NO. <br />/— <br />/�%,.n�� 7-�,L <br />S�� /C <br />PLUMBING <br />TYPE OF FI%iURE OR IT[M <br />Tollet <br />F3atlitu� <br />Lavalory (wash basin) <br />Shuwer <br />Kltchen sin6 8 Jisposal <br />�IShWilShCf <br />CIO�I1f�5 W85I1Cf <br />LaunJry Iray <br />SinA (service/bar/moplelc.) <br />Bachllow pravenler <br />Urinal <br />Dtinkin� Fuunlain <br />Floor Arain <br />Grr.ase tr.ip <br />Rool drains <br />011ier <br />ADORESS CITY2IP <br />J�4 �� <br />HEATSOURCE I <br />PHONE <br />CONTRACT PRICE OF WORK <br />I __ [lectric�_ Gas __ O�hcr I �s <br />C' u <br />✓��i.S �� = � �S�j-- <br />MECHANICAL <br />� NO. I TVPE OF FI%TURE OR ITEM <br />NC - aIr handling wuls <br />_� (__ Forced air systems <br />�_ Gas pipin9 <br />�_ Wnlcrhealcr <br />--/ Gas b;eplaco <br />Gas ran�c <br />/ GluUms dryer <br />..f Ranyehuod <br />�! Exh�mslfan <br />--I Heat pump <br />Uni� hcaler <br />Boiler <br />_ _ Refri�eration <br />W oods�uvo <br />CITY OF EVERETT LOCAL SALES TAX CODE IS ]705 <br />I hereby cerilify Iha� I have road and examined Ihis application and know Ihr, same to be lrue and correcl. All provisions of laws and <br />� ��rdinaces ,�vemin�) Ihis rypo ol wurk will be complied wdh wheUier spocilied herein or noL The granGng of a permit does nol prosume <br />t� � qivc authority lu violalo ur cancel Ihe provision ot any olhur slato or local law regulaUn9 r.onslrucliun or Iho pertormance o( <br />� onslrur.h��n. That I am aulhorized by Ihu ownrr ol Ihis prop�rly �o perlurm lhe worA lur which application is made sand I comply wilh Ihe <br />Slalo Contra�tors Law tf3 2� RCW ar�t :!��11Un WAC. • <br />i <br />-c_<•. S � ' ��_ <br />�i��n:dyrronl Uwn ; ontr,�clorl�hur�fl �iant � ala �� A <br />�� L1 <br />