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_ - � �, <br /> 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 -DE81T 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE AD ESS PARCEL TA7(I.D.# PERMIT# <br /> l 0 13 w�.. �v�e�- ao � Co�-t- � a 0 aq o0 o a �- <br /> LEGAL LOT�N1O. -i BLOCK TRACT r� {] <br /> DESC. 0�"1-'J� � �✓IO -OC7 er�-ett� �� � N �1�� GT IJ�� <br /> OWNER ADDRESS CITY2�P PHONE <br /> � SWft��bOo zOb' k'?K'IQ <br /> �utse �iucenl-iNi �Ol �b AveNu�� ��,H�erbl/1 981�� <br /> TENANTNAME�G'�i�, fn `F`� C��TFOR ERMI PHONE <br /> !11 �/ �e„v .��-��C� �.�7�- <br /> _yi. .I <br /> -T.NI �n <br /> CONTRACTOR �` ���L2 Pqjh}inqlr[. ADDRESS � (3oK �lObbC� CITYIZIP PHONESU3-�SIS�4'4� <br /> ° ��, �a�,n so�-3�z,�g3� <br /> CONTR.LICENSEk���Se�m g7y�� Pc�rNaNd 0 R <br /> SO?�- 7�'SOU� <br /> USE OF BUILDING ( — HEAT SOURCE CONTRACT PRICC OF WOR'( <br /> Electnc _Gas_Olher ��Q QQ(J / <br /> WORK DESCRIPTIQN ) 'J �- J `� <br /> � i , <br /> �'�// T� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM I <br /> Toilel A/C-air handling units <br /> Bathlub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water healer <br /> Kitchen sink 8 disposal Gas freplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry lray Range hood <br /> Sink(service/bar/mop/etc.) Exhausl fan <br /> Backflow preventer Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain Boiler <br /> F�oor drain Refrigeralion <br /> Grease lrap _ Woodstove <br /> Roof drains Other <br /> Other <br /> CIN OF EVERETT IOCAL SALES TAX CODE IS 9105 <br /> I hereby ceritify lhat I have read and examined lhis appliwtion and know ihe same to be lrue and correcL All provisions of laws and <br /> ordinaces goveming this type of work will be complied wilh whether specified herein or not.The granting of a permit does not presume I <br /> to give au�honty to violale or cancel the provision of any other state or local law regulating construclion or the pertormance of <br /> conslmction.Thal I am a nzed by ihe owner of this property to pertorm the work for�vhich application is made and I comply with the <br /> Sla�e Cornract rs Law 18. RGW and�6.a00 WA�� <br /> i <br /> ., ' ., " i ,�.. /G y�' ,\ ^ �` __�..�'� <br /> Signature of Owner/ on o�! onzee A�ent Date <br /> t <br />