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�- a- <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STP.EET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ���!��A <br /> _/ <br /> SITE ADDRESS FU-'i•cy� p•_. �EL TAX I.D.# PERMIT# <br /> 1'�1�'=� �'1��L �ve,�e/� /�e� Sc,/r-- ,9 ��d��'3 nc5a 5�0� ?OD /�' fJO� <br /> LEGA'. LOT NO. BLOCK TRACT OR SUSDIVISION# <br /> DESC. <br /> OWNER A�DRESS �, �x ���CITYIZIP PHONE <br /> � ! � /vK' /�a2GF'P��`�2.s- Syo���.�Ln,ie <br /> e� /)!lG�, INVPsf�1JE�VfJ' .��VC j•,e. � e es q y'�o�;, � <br /> TENANT NAME CONTACT FOR PERMIT PHONF ,r��6 �3l �v/� <br /> �;c,r- S�f,z�,�eRy- <br /> �(7� }7��1 2- E-MAIL�ie,�( ad�e.Y3�YaCO :IOO.ri <br /> CONTf�ACTOR • ADDRESS CITY2IP PHONE <br /> /7/iJ.;�=:3 Nc.•,�. �/�r.r� •R2110 ieo f� S� J�t E�iN��,� �/YZ5 7S"v etv-.;'S� <br /> CONTR.LICENSE il �>ii��rsyy,5- 0 33 � � `I ��e8 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Eleclric Gas Olher ���> 5c� � <br /> WORK DESCRIPTION <br /> �G��� � � ��� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIl(TURE OR ITEM NO. TYPE OF FiYTURE OR ITEM <br /> Toilel A/C-air handling units <br /> Dathtub Forced air systerns <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Water healer <br /> Kilchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas renye <br /> Clolhes washer Clolhes dryer <br /> Waler healer Range hood <br /> Sink(serviceNadmop/etc.) Exhaust fan <br /> Back(low prevenler Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeralion <br /> Grease lrap Woodstove <br /> Roo(drains Other <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this applicalion and know the same to be true and correct. All provisions of laws and <br /> ordinaces governiny lhis type of work will be complied with whelher specified herein or noL Thr.granting of a permit does nol presume <br /> to give aulhorily to violate or cancel lhe provision of any other slate or local law regulating conslruction or the performance of <br /> consiruction. Thal I am authorized by the owner of this property to pertorm lhe work for which application is made and I comply H ith ll�e <br /> State Contractors Law 18.27 RCW and 2�JG200 WAC. <br /> w��i //' <br /> -�"�'�� �'1�-�'�:G� i,2 -y -� y <br /> SiynaWrc o(OwnedContraclor/Aulhonzed Aaent � � Date � (� <br />