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�— PcRMIT APPLICAT'I(�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 <br /> SITE ADDRESS PARCEL TAX I.D.# �E j 0�J�� O3 � <br /> p� 0 <br /> I �„� VYOGiG����Ccl ' �� �G <br /> IEGA LOT NO. BLOCK TRACT OR SUBDIVISION i! <br /> DESC. <br /> OWNER ADDRESS �'N UONCo`�'Yrzir/tU�G�ONE <br /> ISGUCOUI�iC;� 1-11 tiC�UVC_N VG�U grcaclU.ic,iS —/� v( ��Funil ���,��'� /{'��� ��� q597 <br /> TENANT NAME CONTACT FOR PERMI7 f�U N v PHONE <br /> V� \ �{� <br /> �W NI;JZ- ��JN�/E•MAIL �YLS ZI O �{-S(GZ <br /> l <br /> �-� p 7 A DRESS 1Y� � <br /> U i.�J N�;�- <br /> CONTR.UCENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> I�o2l) �VOC1C'�I�UC�tll -�UP _Eledric _Gas_Other <br /> J <br /> WORK DESCRIPTION <br /> ��,�c�c ���� �z� s�����nu�i� tr� �-�� sT�N � DU�Lex ONLJ <br /> , � , . , . <br /> . PLUM8ING � MECHANICAL. <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet A!C-air handling units <br /> � OalhWb � � _ Forcnd air systems - <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Waler heater <br /> Kilchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clolhes dryer <br /> Waler heater Range hood <br /> Sink(service/bar/mopletc.) _ Exhaust(an <br /> �ack0ow proventer _ Heatpump <br /> Urinal Unit healer <br /> Drinking Fountain _ Boiler <br /> Floor drain Relrigeraticn <br /> Grease lrap _ Woodstove <br /> Roo(drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> I hereby ceriti(y lhat I have read and examined lhis applicalion and know the same to be truE and correcL All provisions of laws and <br /> ordinaces goveming this lype of work will be complied wilh whether specified herein or nol.The granting of a permit does not presume <br /> to give authoriry to violate or cancel the provisipn o(any olher slate or local law regulating wnstn�clion or the peAormance of <br /> construclion.That I am authorized by the owner of this property to periorm the work for whicn applicalion is made and I comply with lhe <br /> State Contractors Law 18.27 RCW and 29fi200 WliC.----� <br /> ; � � • � �t.�l�i �.�4 G'7 <br /> Sign� � e'o Ow er/ o ractor/ uthorized Agent . � Date �/ <br /> � <br />