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� PERMIT APPLiCATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 – FAX 425-257-8857 –vdww.everettwa.org <br /> APPLICATION5 ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS���'� 77 ZCF � PARCEL TAY,I.D.tt \PERMIT# <br /> a �c(w a� 3v �s � ooti3� 3yzsa�c�b1 1'D� 1 (- OG <br /> � LEGl+L L07 N0. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CI7Y21P PHONE �(ZS-LI2- ZZ CJ <br /> cr,JE.2-t 13 �o.4TE�,.�.4v G i2 L LL Z"l l �7 2l,C�f .���C{t,(, l�c.�.t_. ���L+-E�T- <br /> TEN,INT NAME CONTACT FOR PERNI7 PHONE <br /> Li1 T- I�•1t. �iL 117i�N.L ��-2-c'/ La/QZv4C. 7S J-Fj S'C7�j <br /> CONzRACTOR ADDRE55 CITYfZIP PHONE <br /> /�/-�� l'1'14[.IJ/�7.I�c.1-L �lll �i7�i r���_ \3��,L1i��5lL�+ 3LU-7J' 7_ ��pg <br /> COnNTR.LICENSE# <br /> Il/�-/11L-"� r'� -�/S J L L <br /> USE OF BUILDING HEAT SGURCE I CONTRACT PR!CE OE WORK <br /> � f�<< _Electric _Gas,_Ofher ,3�j00. vC? <br /> WORK DESCRIPTION <br /> L�ULl4�? in. +'Y. la.i�L S.�v�Ls JXl��y lvl�'7rv /". �iiv� iv SQiJ�C.L, <br /> P�UMBING MECHANICAL <br /> NO. TYPE OF fIX7URE OR ITEM NO. NPE OF FIXTURE OR IT[M <br /> � Toilel A/C-air handling unils <br /> Dathtub Force�air systems <br /> _ I Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> � Kitchen sink&disposal Gas firep�ace <br /> Dishwasher Gas renqe <br /> Clothes�Nasher Clo!hes dryer <br /> � Laundp�!ray Rangehood <br /> I Sink(service/bar/mop/etc.) Exhausl fan <br /> � Backflow preventer Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeralion <br /> Grease trap Woodstove <br /> _ Roof drains , _ Other_ <br /> Other <br /> — �i _ _ <br /> CITY OP EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I heroby ceriti(y thal I have read and examined ihis application and know the same lo be true and correct. All provisions of law�s and <br /> ordinaces goveming this type of work will be complied with whether specified herein or noL The granling of a permit does not presumo <br /> I to givo au�ority to violale or cancel lhe provision of any other sfate or local law regulating construction or the peAormance of <br /> constructi n.That I am authorized by the owner of this property to perfonn lhe work for which opplication is made and I comply with lhe <br /> Slate Contradors Law 18.27 RCW and 296.200 N/AC. <br /> ��1�_—. _ _ _ _ ��//�!U f-- I <br /> Signzture of OwnedContreclor/Authorized Ayenl Date <br /> I <br />