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PERMIT APPLICA�ION � <br /> CITY OF EVERETT PERMIT SERVICE:i � <br /> 3200 CEDAR STREET, EVERETi', 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.N ERM T# <br /> 3 $I�f�flw sv taa no�373`t�S�ooi I �G� Id -O�� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESQ . ��S l7'U I <br /> ONMER R-cJ 6 ADDRESS CITYTP PHONE �y,�,�Z_ <br /> ��VE12F�TT' C-�hTPc\\d�{ t{'c�.�Tk'Jc.,Li.G. -��� 27�1.: <br /> �,- 3uo •z� ��i 2�,c.�r-c�-�a��. a��r `1�z�,, <br /> TENAN NAME CONTACTFORPERMIT rnUNE <br /> P65�i�Y SUN Yi�IMIhIC� I � -��,.b vF1� ,.,�g- <br /> CONTRACTOR ADORESS c.,�l�—/,� (� CITY2IP PHON�\ / <br /> �1 , ' �` -� CUn14'"�'oLU�v -1 �`� I � � Jl.u'��u.�� <br /> CONTR.LICEHSE t w`'S� J u � /� fL yFC.-�, <br /> � � -�C ��.'�.�G�t� �.�n Lr� lw � <br /> USE OP BUILDING` � HEAT SOURCE CONTRACT PRICE OF WORK <br /> �,�� � _Eledric,Z Gas_Olher � I�� ��� <br /> WORKDESCRIPTION �NTI�I. TI l�ut�p�v1 OF I`�t,�(y I�7T�-G�M� <br /> 'j7'�NMINGt SA(.oh{ " Y � �p,uN��Y u�i�+TY i�M . <br /> T�TMLh+1' Y-WI�'�h � W�� � / <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM N0. TYPE OF FI%TURE OR ITEM <br /> Toilet A/C-air handlin��units <br /> Bathtub Forced air syslems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water iieater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(servicelbadmopletc.) Extiaust fan <br /> Backflow preventer Heat pump <br /> Unnal Unit heater <br /> Drinking Fountain �c�ler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other_ <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby centify that I have read and examined this application and know the same to be true and conect. All provisions of laws and <br /> ord:�•:+ces goveming this type of work will be complied with whether specified herein or not.The granting of a pemiit does not presume <br /> to give authonty to violate or cancel the provision of any other state or local law regulating consWction or the p2Aortnance of <br /> construction.That I am authorized by the owner of this property to perfortn the work for which application is made and I comply with the <br /> State�ontradors Law 18,27,R�W and 296200 WAC. <br /> � ' ,G � ' '�' 2 '/� •l <br /> Sig ature of ICon ra IAuthonzed Agent Date / <br /> � z <br />