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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA f38201 <br /> 425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM y 2 _ Za. �O <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT N <br /> l�// .i�?���0 SUtrE /03 (ob2�iy oo O - oc�� <br /> LEGAL LOT NO. BLOCK TRACT OR 3UBDIVISION� <br /> DESC. <br /> ONMER ADDRESS CITV/ZIP PHONE � �2 �y <br /> m.zETz�E� �8✓s��s-s {�,� �.LG />�lla�ePger�.o. Fv�TrlJ,� 98.�6y <br /> TENANT NAME CONTACT FOR'•P�E�R�MIT PI10NE�D �I�j O��f� <br /> Udlt�ms� rl7EG�l, 2n1'G I �tIAyNF 1�`LC(.�'.9�n5 E-MAIL�fO����I� <br /> T ADD E S I 21 N o� <br /> CONTR.LICENSE# �,��m j„�y3p,6 �'(� �/�?j/// � <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PR10E OF WORK <br /> Electric Gas Other ����d <br /> WORK DESCRIPTION <br /> �J�op �y� fl E..4,Q� TD N Eu1 �2EfLEc'TEO <br /> C,Es��n)6 NEz6NT' <br /> PLUMBING ME�HANICAL <br /> NO. TYPE OF FIXTURE OR ITEIM NO. TYPE OF FU(TURE OR ITEM <br /> Toilet A/C–air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) ' Gas piping <br /> Shower Water heater <br /> Kitchen sink&disoosal Gas fireplace <br /> Dishwasher � Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(ser�ice/bar/mop/etc.) Exhaust Nan <br /> Backflow preventer Heatpump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease irap . Woodstove <br /> Roof drains Othet <br /> Other <br /> CITY OF EVERETT LOCAL SALES TA3(CODE I$3106 i <br /> I hereby r,ertify that I have read and examined this application and know ihe same to be true and correct. AII provisions ot laws and I <br /> ordinances governing this type of work will be complied with whether specified herein or not.The granting of a permit does not preeume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construction or the perfortnance of I <br /> construction.That I am authorized by the owner of this pro{�erty to pertortn ihe work for which application is made and I oomply with the � <br /> State C ntractors La�8.27 R�W and 296.200 WAC. �2/Z6/�V <br /> /1L <br /> Sign ture o OwnedContraciorlAuthonzed Agent ate <br />