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PERMIT APPLICATION <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.k PERMIT 0 <br /> L -- • / 'f -W—_ 5G Oa . Oi1005 `)O <br /> LEGA LOT NO. BLOCK TRACT rr �� <br /> DESC. .5- G Fi//- 1p .� ,r r -,_/ ;7lL N <br /> OWNER ADDRESS UU1Ylaar PHONE <br /> 42-11 'A t .lc 7�1' ISL � IIL1/) 7f �3PL�,92- <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> .N <br /> JrjhN S�cwNfJ� L 9vS- <br /> i -�i3b F�9Z <br /> CONTRACTOR (j0 rr, ADDRESS ?,CqCj ft5%!c 1;-cC1TYRIP PHONE lJ76-jf y-7 O <br /> LZ <br /> CONTR.LICENSE �'Y► �14�q' <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> /X /7/C I ,L Electric —Gas—Other �j d D • �, <br /> WORK OESCRIPTION <br /> .c txls4iu�� � <br /> MT-4':J.% . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet _ AIC-air handling units <br /> Bathtub _ Forced air systems <br /> _ Lavatory(wash basin) _ Gas piping <br /> _ Shower _ Water heater <br /> _ Kitchen sink E disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clothes washer _ Clothes dryer <br /> Laundry tray _ Range hood <br /> _ Sink(servicelbar/mop.etc.) _ Exhaust fan <br /> _ Backfiow preventer _ Heat pump <br /> Urinal _ Unit heater <br /> _ Drinking Fountain Boiler <br /> _ Floor drain _ Refrigeration <br /> _ Grease trap _ Woodstove <br /> _ Roof drains _ Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3108 <br /> 1 hereby centify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> construction.That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> State Contractors Law 18.27 RCyV and 2D6.2"AC. <br /> Slgndldreo erl ontractor/ ulhorize gent ate <br />