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P�RMIT APPLICA�IOoV <br /> CITY OF E'VERETT PERMI� SERVICES I� ` i 5'--� 7 <br /> 3200 CEJAR STREET, EVERETT, WA 98201 <br /> 425-257-88"0 - FAX 425-257-8857-www.everettwa.org <br /> APPLICIITIONS AR[ ACCLPTED FRONI 8 AM TO 4 PM <br /> SITE ADDRESS � PARCEL TAY.I.D.# PERMIT# <br /> 3z�/ Lo,r.���l /��• r�Ao� i / -Gzy <br /> LEGAL LOT NO. � BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER r ADDRESS CITY/ZIP PHONE <br /> �\�� Cr� /d'+�/V«.fEl-.//`/A�inn 1�/4JS-t �L�� LV.-�dcr� �U��`ii' fOLQ� �YtJ�1za-�9LY <br /> TENANT NAME C/O�NTACT FOR PERMIT / PHONE <br /> � /�(.�� �7wwrol �5'cr}'�.ry_ fd'8S <br /> E-MAIL <br /> CONTRACTOR ADDRESS CITYIZIP PHONE <br /> �R���� ��,� �y �ti..w,� ,� rvos� Cvzr�-�sy-S�vs <br /> CONTR. LICENSE if •^`�^ � �L� <br /> C/9f qcc9 �OQ� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ('r � �'b l.� 9 � <br /> �• �7 �Y%Ce _Electric �as_Other � <br /> WORK �ESCRIPTION <br /> . <br /> 5<1' �� �n �c� i.� �'��'� /���5 a��« 7�t i�� 6s. P��J�.� S �a 0 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet !VC—air handling units <br /> _ 6alhtub y orced air systems <br /> Lavatory(wash 'iasin) '�i Gaspiping <br /> Shower r _ ater healer <br /> Kitchen sink& disposal Gas lireplace <br /> Dishwasher / _ Gas range <br /> Clolhes washer / 'lothes dryer <br /> Water healer Ranc�e hood <br /> Sink (service/badmop/etc.) 'fi Exhaustfan <br /> Backflow preventer _ Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Re(rigeration <br /> Grease lrap Woodstove <br /> � _ Roof drains _ Olher <br /> Olher <br /> CITY OF EVEREII'LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify thal I have read and examined this application and know lhe same lo be lrue and correcL All provisions of laws and <br /> ordinaces goveming this lype of work will be complied with whelher specitied herein or not.The granling of a permit does not presume <br /> lo give authority lo violale or cancel the provision of any other stale or local law regulating construction or the performance o( <br /> consVuclion.That I am aulhorized by the ovrner of tr.is property to perform lhe�vork for which application is made and I comply with the <br /> Stale Contractors Law 1827 RCVV and 296.200 WAC. <br /> �� ����� <br /> Signature of OwnedContractor/Authorized Agent ate �/ \ <br /> J <br />