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PtRMIT APPLICATI(�N <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 /��j� ?� �7 <br /> SITEADDRESS `/""`'�✓ G <br /> PARCEL TAX I.D.# PERMIT ll <br /> 7.,� C / A�'CG� S( <br /> LEGAL LOT N0. � � -�/ - L <br /> BLOCK TRAC7 <br /> �ESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> ��� j��-�zsy <br /> TENA TNAME ' I CONTACTFOR PERMIT <br /> PHONE <br /> Ja�' s���,Nc y.�r-vlz- s��.f' <br /> CONTRACTOR /i�K �/I['S � ,t.(y/cte7q'U ADDRESS <br /> �. ��, n� )3oK /Y�3 urrrzia�t , pyONE <br /> CONTR.UCENFE p GL4 C�"J�� ~���1 y,J��22-fd <br /> �c(�Lcu rtr�S�l <br /> USE OF BUILDING y�`��� <br /> HEA7 SOURCE CONTRACT PRICE�O/F WORK <br /> � ��i �C. �}+*q�<< "�-`^� � _Electric �Gas_Othor (`_-. - 7�� <br /> WORK ESCRIPTION ��" """"`"'� 4� 'T�fiS <br /> //"'�C <br /> � _ �G�--v� C+ r, J <br /> PLUMBING MEC ANI ��Q <br /> N�� TYPE OF FIXTURE OR ITEM Np, � �G(d <br /> �0 RITEIb� <br /> Bathlub A/C-air handling unils , v <br /> _ Lavalory(wash basin) � Forcod air systems <br /> Shower T� Gas piping <br /> � Kilchen sink R disposal ._L_ Water healar <br /> Dishwashcr _ Gas fireplace <br /> Clothos washor _ Gas range <br /> Waler hoaler Clolhes dryer <br /> _ Sink (servic�/bar/mop/olc.) � Range hood <br /> DackOow proventer _ Exhaustfan <br /> Urinal Heat pump <br /> Drinking Fountain _ Unit hea�er <br /> Floor drain _ Boller <br /> � Grease trap _ Re(rigeralion <br /> Roof drains _ Woodstove <br /> Other _ Olher <br /> I _ -- _ — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify ihat I have read and examined this applicalion and know tho same lo be true and correct. All prowsions of laws and <br /> orAinaces govemin0 Ihis type of work will be compliod wilh whelhor specifiad herein or noL Tho granling of a permit does not presume <br /> lo give authority lo v�olale or cancel lhe provision of any other state or local law regulaling conslniction or tho pedormance of <br /> �construclion. That I m authoriz by the ownar ol this propeAy to perform Ihe work lor which apF�lication is mad�f and I comply with the <br /> ate Contraclors aw 1g.27�antl 06.200 WAC. <br /> _ �;� / �/`��nS <br /> Signatu�.o OwnedContractor/Authonz Agent Date <br /> ------- - --- '/a <br />