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r� <br /> � �. <br /> 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.It p x <br /> 2�18 (��Y V�• G7O4�`t�ba2o2s Qo•E3qlb82o3ao (��07 �3 y <br /> LEGA LOT N0. BLOCK TpACT OR SUBDIVISION N <br /> DESC. ZS �Lq fJ'O �og Z�^O� <br /> OWNER ADDRESS CITY2IP PHONE <br /> �NotiaMlSft Co. Ca�,Y�rtM��YTrzctST f'•°� �°X SS3 ��04�-1�� <br /> TENANTNAME CONTACTFOHPERMIT PMONE <br /> �ill�t�cT�l� �tl. �T�cT-� I ctn�Y i��:.wNsoµ ,a�u+rr�-5 �.zr 2s2-2r�3 <br /> G#o�bY 1�/F��I•k�D E�NIAILu�rdMCAar �arklMw... <br /> G'uA�urf rMF�v�M�T Go. ��c�sYa�. �yca'tETT- �b-bs'n -�30�- <br /> CONTR.LICENSE 1 �8�I <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ���LC �Eleclric _Gas_Olher I � L�-- p(� �o <br /> WORK DESCRIPTION <br /> -�'�Nk+� I�l�1�vEM��T <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM N0. TYPE OF FlI(TURE OR ITEM <br /> _ Toitet A/C—air handling units <br /> _ Bathlub Forced air syslems <br /> _ Lavalory�wash basin) Gas piping <br /> _ Shower Water heater <br /> _ Kitchen sink 8 disposal Gas fireplace <br /> _ Dishwasher Gas range <br /> _ Clothes washer Clothes dryer <br /> _ Water heater Range hood <br /> _ Sink(service/bar/mop/elc.) Exhaust fan <br /> _ Backllow preventer Heat pump <br /> _ Urinai Unit heater <br /> _ Drinking Fountain Boiler <br /> _ Floor drain Relrigeration <br /> _ Grease trap Woodsiove <br /> _ Rool drains Other <br /> _ O�her — <br /> CITY OF EVEREIT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritily that I have read and examined this applicalion and know the same to be Irue and correct. All provisions ol laws and <br /> ordinaces'goveming this type ol work will be complied with whelher specified herein or nol.The granting ol a permit dces not presume <br /> lo give authority to violale or cancel the provision ol any other state or local law regulaling consiruction or Ihe perlormance of <br /> construction. a1 I am auth ized b owner ot Ihis property to perlorm the work lor which application is made and I comply with Ihe <br /> Slate Contr ors Law 82 CW aad 96. 00 WAC. <br /> . � •Q <br /> Sig atur ol Owner IractodAuthorized Agent Oate (/ <br /> ` <br />