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� <br /> I PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-B810— FAX 425-257-8857—www.everettwa.org ��� -0 i <br /> � �- L 7C�/`>/ � <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � <br /> I SITE ADDRESS PARCEL TAX I.D.# PERMIT# �'� <br /> (lQ1f -A�RP�K� RoaD � J �-� <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION M <br /> DESC. <br /> OWNER ADDRESS CITY2IP Pqt�y63���1s I <br /> So�..tw Lo,ro G�RP Po S3ox 7S�ov D�•1►�t,t'iL 4�r� � <br /> TENANTNAME CONTACTFORPERMIT PHONE'jS3• 5�•3��jt <br /> Z- 1 \ Stonee I kWRo� P►�RC¢u E-MPJL b.i►o�arytc �+ <br /> 0 AD RES CI /ZI�H�RE <br /> S,ME 30�,�.�o.u,L�� Z��.A Yr�ac� 1'ntswy�.+� 1s)-sn•3�'zL � <br /> � COMR.LICENSEN 2�,'D4 `�840-� � <br /> S�SeLsc 43Tc+� 4,cP <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> COMN1Cqtt frt�R� Electric _Gas_Other 500�.�0 i <br /> WORK DESCRIPTION � I <br /> ReP�4��. 4x�:r,�3/ �l AS P0.�Ct s ►c*� �ocj�..t��Cr w1� i <br /> u�w o•,+as o i So�+�+e s►sc �we.�wrer <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM NO. TVPE OF FIXTURE OR ITEM <br /> 7oilet _ P✓C—air handling units <br /> Bathtub _ Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Waterheater <br /> Kitchen s�nk&disposal _ Gas fireplace I <br /> I _ Dishwasher _ Gas range � <br /> Clothes washer _ Clothes dryer <br /> Water heater _ Range hood �� <br /> Sink(service,'badmopletc.) _ Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal _ Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain . _ Refrigera�ion <br /> Grease trap Woodstove 1 <br /> Roof drains � Other S 16M <br /> Olher — <br /> ICITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> � � I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or not The granting of a permit does not presume <br /> to give authority to violate or cancel ihe provision of any other stale or local law regulating construction or the pertormance ot <br /> construction.That I am authorized by the owner of this property to perlorm tne work for which appiication is made and I comply with ihe <br /> � State Contractors Law 1627 and 296.200\"'AC. <br /> �1�. _�� /--�li ���?- 07 <br /> Signature of OwnedContractodAuthorizetl Agent Date / <br /> tZ <br /> �-- –--– — <br /> , <br />