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F �RMIT APPLICATIVN <br /> CITY OF EVERETT PERMIT SERWICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX �725-257-8857 -www.everettwa.org � <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM /� 3�j --0� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT p <br /> I-13S Cvlu, A�.�e '�0� �69�8 D - <br /> LEGA LOT NO. BLOCK TRACT OR SUODIVISION N <br /> DESC. <br /> OWNER ADDRESS CITY�[IP PHONE <br /> �Ai-l-l.�y� G`�c' l� /vd5 <<�lbv A•� t 1—���,ct�!- �'Sr.,t1 `1,�5 -37�{-73�IS <br /> TENANT NAME CONTACT OR PERMIT PHONE <br /> �[35���6c- �1.�08 <br /> �����{ v� C��t l� �oi� �me� e r E-MAIL <br /> "�" �'sR F0.Sk l-lrnl-�ng jAl� +��_ a(;1 S W Cn,9iw Ri7 �n¢ir t�_— <br /> y,�5 - 355-3�� 1 , <br /> CONTR.LICENSE# rn�l NI{�T- ���� ��..• J/��o%7 �t1Cr� n^„O�� <br /> 1 �� 7 2�( <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WO�RK <br /> U <br /> r <br /> _Eleclric ✓Gas_Olher -��' 3(`,�,4 r" <br /> WORKOESCRIPTION�y�,�j<<,l (��i� �`P`ny 'f'O F„r��ncc <br /> T���i«ll fjo�o e{f��e�La C�«5 �-�rr�c <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br />� Toilet A/C-air handling unils <br /> Bathtub �/ Forced air systems <br /> Lavalory(wash basin) ✓' Gas pipin� <br /> Shower Water healer <br /> Kitchen sink&disposal Gas firep'ace <br /> Dishwasher Gasrange <br /> Clothes washer CloCres dryer <br /> Waler heater P.an9e hood <br /> Sink(service/barlmopletc.) Exhausl(an <br /> Back(low preventer Heal pump <br /> Urinal Unil healer <br /> Drinkinc� Fountain Boiler <br /> Floor drain Refnyeralion <br /> Grease lrap Woodstme <br /> Rool drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TNC CODE IS 3105 <br /> I hereby ceritify that I have read and examined this applicalion and know the same lo be true and correcL All provisions oi laws and <br /> ordinaces goveming Ihis type of work will be complied wdh whethrr specilied herein or not.The granting of a permit does not presume <br /> to givo authority to violate or canc�l ihe provision of any other state or local law regu�aling construclion or the performance ot <br /> construction.That I am authorized bp the owner of this property lo peAorrr�the work for�tihich applicalion is made and I comply with the <br /> State Co ctors Law 70.27 RCW and 296.200 WAC. <br /> �,�rv� ��`(�.�M,,,� 1 �� � " �g <br /> SignaWre of OwneriContraclon uthonzed Ayent Date <br />