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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.# PERMIT N <br /> �((�Z� f}iv �/� 0053�9Db0D Z gv�,o�-c3a <br /> LEGAL LOTNO. BLOCK T C�Or,Ca c G�� <br /> DESQ 1M.o'v u <br /> OWNER AODRESS CITV/ZIP PHONE �ZS <br /> ��,�e Cl�,ay2�l ll6 ZS��i��'fl�l �e D ��.e�( 1v�� 33s qrZti <br /> TENANT� CONTACT FOR PERMIT PNONE <br /> cn�,�e, CG�a�( � llobe�/�wav� 42s� 77�� 470� <br /> CONTRACTOR �G ADDRESS CITY2IP PHONE ��S <br /> J'�ZuGtM /�'YGt1G�P.�rY.�, L p 7�, <br /> CONTR.LICENSE• �ZD J /y''°��CNG � rSV�•`� `U�'w �73 ""' � <br /> �evaN�c�63.aM "� <br /> USE OF BUIIDING I HEAT SOURCE CONTi2ACT PRICE OF WORK <br /> C��VG� _Electric _Gas_Other � ��U� '� <br /> N'ORK DESCRIPTION <br /> � <br /> �,�� �i �ue� .G� <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR I7EM NO. TYGE OF FIXTURE 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&disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> � Clothes washer CloMes dryer <br /> ' Laundry hay _ Range Rood <br /> Sink(service/baAmop/etc.) _ Ezhaust fan <br /> Backflow preventer _ Heat pump i <br /> Urinal _ Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Rehigerati0n <br /> Grease trap _ Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE!S 3105 I <br /> '� I hereby ceritiy that I have read and examined this application and know the same to be true and correct. AU provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specifed herein or not The granling ot a permit does not presume <br /> � ro give authority to violate or cancel the provision of any other state or local law regulating wnstruction or the performance ot <br /> I construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> I State Contr s or Law . CW and 296200 WAC. <br /> c�Gr,t S'�l9�� <br /> �natu e o Owner Contractor/Authorized Agent Date <br /> Ih <br /> /� <br /> _J <br />