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PE�htMIT APPLI�ATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 4�5-257-8857—www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS �Ii P/'�P •F� G(/f� PARCEL TAX I.D.# PERMIT# ' <br /> a C� � <br /> 3 0� �ra � t� (7 L r O � O ' n�� LF'03 ' .Z <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. ' S � ! L' I <br /> C <br /> OWNER ADDRESS CITYIZIP PHONE <br /> ` 3 �a� g�o�,�r��Wr �/�S -a5�-s ��l <br /> SC � i rn �v� P� 7'n U F< (-n7��5 L L.L Gi;P�P�-1- �lrf�3ol <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> r <br /> �/�,� ,c-�, � l ��h ,» �.� T �i��- as� -� �s > <br /> CONT f�CTOR ADDRESS CITY2IP PHONE <br /> �f�olc��T� �e �h�t-�emFn �, :Z'n� 3•73� S�nr�-�� /�u� �/a5-3ci3 -�o7:� <br /> CONTR.UCENSE# ���;.� jg r �Fr.� �f-� I�VI� <br /> /IFFc2/�f�o�['F o>���,/ <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> fC F�i,C�Nl>� P _E el clric _Gas_Olher � �� 3 a5 <br /> WORK DESCRIPTION <br /> /� � m� /1/, l���rSr� J- c��Ls �«s F <br /> PLUM8ING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _( Toilel A/C-air handlinc� units <br /> _j Bathtuo f Forced air syslems <br /> � Lavatory(wash basin) Gas i in <br /> PP 9 <br /> Shower _L Waler heater <br /> �- Kitchen sink 8 disposal Gas fireplace <br /> _ Dishwasher Gasrange <br /> Clothes vrasher Clolhes dryer <br /> i Water heater � Range hood <br /> _ Sink(servicelbar/mop/elc.) _L Exhausl fan <br /> __ Backflow preventer Heal pump <br /> _ Urinal Unit healer <br /> _ Drinking Founlain Boiler <br /> _ Floor drain Refrigeration <br /> _ Grease trap Woodstove <br /> _ Roof drains Other <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerili(y lhat I have read and examined lhis application and know lhe same lo be true and correcL All provisions of laws and <br /> ordinaces goveming lhis type of work will be complied wilh whelher specified herein or not.The granting of a pemit does not presume <br /> to c�ive authority to violate or cancel lhe provision o�any olher slate or local law regidalinc�construction or the peAormance o( <br /> construcfion.That I am authorized by Ihe ownar P this property to perform lhe work for which application is made and I comp�y with lhe <br /> State Contractor�8.27 CW and 296�AC. <br /> f :/ /� "�.?7 ✓l� i "� �'C7(o <br /> Signature o Ovmer/ConlracU�r/Authonzed Agent Date <br />