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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-www.everettwa.org � `�Z�O <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM w �� Wo� _ �� <br /> SITE ADDRESS PARCEL TAX I.D.p PERMIT N <br /> I!!2 Golb v� ,�,K,. ft' 96t..i Ooy68622/02l00 /a . o9So <br /> LEGA LOT NO. 9LOCK TRACT OR SUBDIVISION K <br /> oEsc. Zl � 22 22( � - O 1�'�Sl•}5 ADD -}^� ��c��'�'�' <br /> OWNER ADpRESS` CITY/ZIP PHONE <br /> avA�+Q�So.wCT l�r►I'�^a.� 111Z Ga�b�/ ��� ��/C1'G/l /�-��-Z�' y' <br /> TENANT NAME CONTACT FOR PERMIT PHONE a I���� <br /> I �`Ga..1 C'..,•r0.� Y� ' e� <br /> E-MAIL Cwr/�w«OSo+►twt . <br /> $ �ITYIL Nt <br /> CONTR.LICENSE p <br /> USE OF BUILDIkG HEAT SOURCE CONTRACT PRICE OF WORK <br /> Exl S + 1� L�`�' d�� �Eleclric _Gas_Other � Z � ��� <br /> WORKDESCRIPTION C�nyii'uL.� ,��„i y�c���S pv� (J� cu� SE C.orr�cr o C.�[SSti �� or-}' <br /> c:e..��,� s;�;..y �.,a p�,;,.�- a� �� „i��u�l\s an� ra�`��- d n � re _e��s�K� P <br /> s•���r�s. l��. �/1" �(y�,✓aa� -}v i•,k�-�o�- o{' u;rc,W4I1S {'v� a���+icvw� S�PP•� <br /> t��tc� n�Y.� o Nt�z� � � rv�o c siz��rs '�O c�'r^ca'F a� enclose ra��inti W�N S�w <br /> PLUMBING MECHANICAL a►� ¢� ,�, <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Ranc�e hood <br /> Sink(service/barlmop/etc.) Exhaust fan <br /> BackOow prevenler _ Heatpump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigera�ion <br /> Grease irap _ Woodstove <br /> Roof drains Olher <br /> Olher <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceAify that I have read and examined this application anA know Ihe same to be irue and correct All provisions of laws and <br /> ordinances goveming this type of�vork wil�be complied with whether specifed herein or not.The granting of a permit does not presume <br /> to give authonty to violate or cancel the provision of any other state or locai law regutating construction or the pedormance of <br /> construction. That I am authorized by the owner o`tnis property lo pertorm the work torwhich application is made and I compty with ihe <br /> StaVe�aclors Law 1 CW and 29G200���AC. <br /> _ >G��-.-� la,n�c�.l,,.1 /�^_I /14 <br /> Signature of OwnedContractor/Aulhorized Agent D te <br />