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i <br /> P�RMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everethva.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.f1 PERMIT� <br /> 7y0� o�yr+,�ic .tiiz ! ✓��j Ov3 i�/Odaon 6id� <br /> LEGA LOTNO. BIOC TRACTTfvf!l�.Y ��7(L,Q /uADv �/-,C� O /�' �(��' LOjEa/ <br /> DESC. �/ /�rR� ��'e c7�cn� o- n.q FFelL2233Y—d0/ <br /> OWNER RESS CITY2IP PHONE <br /> `'bKsa �f1i2K �Rvp�lt77sS . L(C zS�� '7�7ycda-. OrZ p�v�iu� ,�'2ci3 YZS�30s —3z7/ <br /> TENANT NAME ' I CONTACT FOR PERMIT � PHONE <br /> C//�-c.�--,,,7 Carz�s �r�n�r- �zS=�o�sz 7/ <br /> CONTRACTO R�Ft� (L!�Ct R�'R�,�'�'"�f�ppDRESS��3L ��rN ,�� CITY2IP PHONE <br /> C�,a�r ,y7� i �aG—�73 i�z/ <br /> CONTR.LICENSE N <br /> - ��o,��fi 1 i��C� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � r(t��;- �ij�' �Electric _Gas_Other Z7 �OU � <br /> WORK DESCRIPTION N�� ' <br /> �s�z0 — F'�f�'fN�f �2 GQ�-�`l-% <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF F�XTURE OR ITEM NO. iYPE OF FIXTURE OR ITEM <br /> _ Toilet A/C—afr handlirg units <br /> Bathtub Forced air;ystems <br /> _ Lavalory(wash basin) Gas piping <br /> Shower Water heater <br /> ✓ Kitchen sink&�Ci�posal Gas fireplace <br /> Dishwasher Gas range <br /> _ Clothes washer Clothes dryer <br /> _ Water healer Range hood <br /> Sink(service/badmop/elc.) Exhaust fan <br /> Backflow preventer _ Heat pump <br /> � Urinal Unit heater <br /> Drinking Founlain Boiler <br /> _ Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceriti(y that I have read and examined ihis application and know the same to be true and correct. All provisions of laws and <br /> ordinaces goveming this lype oi work will be complied with whather specified herein or not.The granting of a pertnit does not presume <br /> to give authorily to violale or cancel the provision of any olher stale or local law regulating construcHon or the perfortnance of <br /> conslructio Thal I am authorized by the owner of thfs property lo perfortn the work for which appllcaBon fs made and I comply wilh the <br /> State C ra tors Law 1837 RCW and 296.200 WAC. <br /> ���� �=Z3�-0( <br /> Sign ture of Owne o actor/Authorized Agent Date <br /> + � <br />