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P�RMIT APPLICATION <br /> CITY OF EV�RETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 -www.evereltwa.o._ <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 7 `'� 7� <br /> SITE ADDRESS PARCEL TAX I.D.# � PERMIT tt <br /> � •fG / ��U/�KJW13 Li;- o � y3�73�1700 /GG b�liU1-CJO'� <br /> LEGAI LOT NO. BLOCK TRACT D� U C <br /> DESC. I '� � 7 " -C� J- U _ - � ) L� _ <br /> OWNER ADDRE55 CITY2IP PHONE b„�o _.�,�G�i <br /> yis"- <br /> G �_Yl'� f �J �-! i M D�n.G � �- L ��. .�a� �n i� )�U/,`/I/8 l'i 12.I? ��i lc: (7 _ <br /> TFNANT NAME CONTACT FOR PERMIT PHONE <br /> /va n. • .Ro'u-r'n 1�'l�w+� ,: y L/ Z �`�7o -y �o� <br /> CONTRACTOR ADDRE55 CITV'21P PNONE <br /> a Cu N/_/2 <br /> CONTR.LICENSE N <br /> USE OF BUILDIt�G — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ti/ G .`�' Electric Gas ✓Other <br /> WORI(DESC�IPTION <br /> D�=r,-� a�, i r,�N- <br /> PLUMBiNG MECHANICAL <br /> NO. TYPE OF fIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM I <br /> Toilel A/C-air handling units <br /> Bathtub Forced air systems � <br /> Lavatoi;(wash basin) _ Gas piping <br /> � Shower Water heater i <br /> Kitchen sink&disposal _ Gas tireplace i <br /> Dishwasher Gasrango <br /> Clolhes washer Clothes dryer <br /> Waler heater Rango hood , <br /> Sink(service/bar/mop;e�c.) _ Exhausl ian <br />, _ Backflow preventer _ Heat pump I <br /> Urinal Unit healer <br /> Drinking Founlain _ 3oiler <br /> Floor drain Refrigeralion <br /> Greaso trap _ Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I have read and examined lhis appiication and know the same to be true and correcl. All provisions of laws and <br /> ordinaces goveming lhis type of wurk will be complied with whether specified herein or nol The granting oi a permit does not presume <br /> lo givo aulhority to violate or cancel lhe provision oi any other state or local law regu�aling conslruclion or the pedormance of <br /> construclion.That I am authorized by the o�ner of this property to periorm tha work for which application is made and I wmply with the <br /> State Contractors Law 1827 RCW and 296200��-' <br /> �- ,�_—��-� J �>/6 <br /> Signature o t�r/Con Sr AulhonzedAt,�enl Date <br /> I — ------- <br />