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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 <br /> l�rr LICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM G —� ��(`� <br /> SITE ADDRESS PARCEL TAX I.O.p PERM;T p _ <br /> �S�a. L'�/6 AuG �e-r-�t/ �:4'�6I DoS� /D�/Gv � ''G �ll,� <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION p <br /> DESC. <br /> OWNER ADDRESS CITYfZIP PHONE , <br /> Jo�»v' P�rfrie,�- �r�.��.�ft <br /> �i,�l�.. ��,� - �ts as.�v ��✓6;, �.� ���..-� �"�� j <br /> TENANT NAME � i.ONTACT FOR PERMI PHONE <br /> 5'as- .3ys-y7�8 <br /> /�'Jlis.sa.�� �n��s l'a%/ Gu�i/ E-MAIL <br /> �N�AZc� . E IN/ZIP PHO E <br /> CONTR.UCENSE# �' / '� <br /> ��Y,�i��r+ U`'1C�Sk.S��un�cd`��) �/��-�� E=,Z�,.-, c�^-�`"�7 I�i <br /> USE OF BUILDIN� I HEAT SOURCE I CONTRACT PRICE OF WORK � <br /> ���5�9� Unp�j� r /���/ _Electric �Gas_O�her � .�r�C • �`l� <br /> _�„� dC• <br /> WORK D CRIPTION <br /> - '�t�.11r.t� �,� s� hcr- illkw�ned-ed Si,�h. <br />! <br /> PLUM8ING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM I <br /> Toilel _ A/C-air handling units I <br /> Balhtub Forced air syslems I <br /> Lava�ory(wash basin) _ Gas piping <br /> Shower Waler heater II <br /> Kitchen sink&disposal _ Gas tireplace <br /> Dishwasher _ Gasrange � <br /> Clothes washer _ Clothes dryer I <br /> Waler heater _ Range hood I <br /> Sink(servicelbar/mop/etc.) _ Exhaust fan <br /> Dackflow prevenler _ Heal pump I <br /> Urinal _ Unill�eater <br /> Drinking Founlain 8oiler I <br /> Floor drain _ Refrigeration <br /> _ Grease trap Woodstove <br /> _ Roof drains � Other S��%�U/ <br /> Othcr <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby cerilify that I have read and examined this application and know the same to be true and correct All provisions of laws and <br /> ordinaces governing this type oi work will be complied wilh whether specitied herein or noL The granting of a permit does not presume <br /> to give aulhority lo violate or cancel lhe provision of any olhe�state or local law regulating construclion or Ihe pedormance of <br /> construction.That I am authorized by Ihe owner oi this property lo perform lhe work(or which application is made and I comply with Ihe <br /> State ConUectorg Law 18.27 R�W and 296.20D WAC. <br /> ,� , � . (s�/% <br /> Signature of O edContractor/A i orized Ayent Dale ,�' <br /> � <br />