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J. . <br /> PERMIT APPLICATION <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 T/U(I.D.# PE�I T# n <br /> ��7�.� -P-o�w�Y Av� , oc�h-�37�R�.b��� c�o , � - �' <br /> LEGAL LOTNO. BLOCK TRACT <br /> o�sc. �� -�'}{Rt! � � `�Z "17'U� <br /> OWN[R pDDRESS CIIY/LP PHONE <br /> �:AT�• &�'��`bW��1 �;�Ttt�'r' I�,{• ��l'T9 �wh+� A�� �.Vi1z ;z �b2�l <br /> TENPNT NAME �J��`�.����� .������� 91�TACT FOR PERMIT PHONE <br /> ���M'� � o1NYJl:I�'-- I ���1� �lHa:.'�rl:�f= (`{'��) '.�5 3 — bf=��'a <br /> CONTRACTOR ADDRESS CINlLP PHONE <br /> Tx� iN-nr��.-n�c, , iN�, �o. � M��r-I�.-�4p q�,rr� (���)<r,�. �-r�� <br /> CONTR.LICENSEO T�.�NT�.���.���� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> r d � <br /> `�A}7.�-i}�!�(!'C•- �TUiZI�L'���. _Electric _Gas�Olher l� ��J� �'�v "� <br /> WORK DESCRIPTION (�� (� <br /> �' '�-.�.�- ` �n'.�� �--M� f' �i �,' { Wl���l !'I [ yr.ti�. �. <br /> •�=n,T}�N�" f�f'l::�T'��1, '�.�tll��N�l� . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handiing unils <br /> _ 6alhtub Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Shower Waler healer <br /> Kildien sink&disposa� Gas(replace <br /> Dishwasher Gas range <br /> _ Clolhes washer Cbthes dryer <br /> Laundry tray Range hood <br /> Sink(service/badmop/elcJ Exhaust fan . <br /> Backflow prevenler Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> _ Grease trap Woodstove <br /> Roof drains Other � <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE iS 3105 <br /> I hereby ceritify lhat I have read and examined lhis application and know lhe same to be true and corred. All provisions of laws and <br /> ordinaces goveming this lype af work will be complied with whelher spedfied herein or noL The granting of a pertnit does not presume <br /> to give aulhoriry lo violate or cancel the provision of any ollier state or loral law regulaling constnidion or the pedortnance of <br /> consWction.Thal I a eu0io�taed by the owner of lhis property lo perform the vrork for which appiication is made and I comply with the <br /> Stale Conh tors L 18.27 R W and 296200 WAC. <br /> .-��7 <br /> �� rJ3-��- aW <br /> Signatur er onVa or/Authorized Agent Date �/� <br />