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PtRI'�IIIT APPLICATIOIV <br /> CITY OF EVERETT PERMIT" S�RVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-885'—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS :�2 ( � t VE2cc�EEIJ. w t7• P.4RCEL TAX I.D.# /P�ERMI,T/# <br /> �UE2CTl wA �l'� 2c3 C� �1 ��' ��� <br /> LeGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER (1� ��� n ��f L f� ADDRESS CITY2IP PHONE,��(,fc�J �<5_��77�. <br /> � -11U� MLk JR . w ,hiS � 2i° _ St�+ [%4-- , ivA �11' r�.S, <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> �1� �� r-2,u�r.� i«.,,+ -C��vC)23u -�2�2� `�"�5 - �`�"- 'C� 3 . <br /> CONTRACTOR �`�� , ��p� `� � �j{�DDRESS CITY2IP PHONE <br /> ��L`-- <br /> CONTR.LICENSE# / <br /> �l��r a -� ._�.—` <br /> USE OF BUILDING HEAT SOURCE (� CONTRACT 'c OF WORK <br /> I _Electric _Gas_Other I ��i"� <br /> IVORK DESCRIPTION <br /> � � �'� y��,,.�.�' .�=f��� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI;(TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A1C—air handling unils <br /> Bathlub Porced air systems <br /> Lavatory(wash basin) Gas piping <br /> Showar Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Cbthes washer Clothes dryer <br /> Laundry tray �- Range hood <br /> � Sink(servi�e/bar/mop/etc.) �/.����4`� � Exheust fan <br /> _ Backflow preventer �1.�:c�. _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeretion <br /> Grease trap Woodstove <br /> Roof drains � Other <br /> Olher <br /> CIN OF EVERE'IT LOCAL SALES SAX CODE IS 3705 <br /> I hereby ceritify lhat I have read and examined this application and know the same to be true and wr�ecL 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 /> lo give authority to violate or cancel lhe provision of any other state or local law regulating construction or ths performance of <br /> construction.That I am authorized by the ownerof this property to per(orm the work for which applicatinn is made and I ccmply with lhe <br /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> ' ���/I/'�-. i I- 2�1-�J ZI� <br /> Signature of OwnedContractodAuthdrized" gent Date ��Z <br />