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PERMIT APPLICATI4N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, 1NA 98201 <br /> 425-257-8810—FAX 425-257-8857—wv�w.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM r�_�C`j .�� <br /> SITE ADDRESS PARCEI TAX I.D.N P���,T 1�j �^ C/�/ <br /> '���' GOUb`�,4VE �/L d� � <br /> LCGA LOTNO. BLOCK TRACTORSUBDIVISIONp <br /> D[SC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> C��) <br /> ��.oT bh� ��1.�ST1�TE Z�v�- Go�-�� �kv� �T� 1200 �/�T �0201 2�z-s4u7 <br /> TENANTNAME � CONTACTFORPERMIT PHONE L� <br /> �G�-�'�� �-TNv� NAN�Y t��YwboD E-MAILI�•I1 �dval� ln{u�iCY <br /> � u • � <br /> Ti��Nt1 �ot�sf�V�TIroM g�� '-(�.4v�s. s���o s�T�,� 2�(0.�0����ob <br /> CONTR.LICENSE#�� . y � , • �G • n n�.y_�2 �, q e�,I� <br /> ��-N �v �- �zi <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> 'p�'�(�Lfj _Eleclric _Gas__Oiher ���—^ <br /> WORK DESCRIPTION <br /> p����ti r-���c-N�tirr ir�r�v��7 Ii��wD►N� s�L�11V� <br /> p�''lo�lo� , Prk�TloN �l.��T�c-�-. GEIUN(� FlN6stl�s&�U��--.�h-�[� <br /> PLUMBING MECHANICAL <br /> N0. TVPE OF FI%TURE OR ITEM NO. TYPE OF F�%NRE OR ITEM <br /> Toilet A/C-air handling units <br /> Dathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal _ Gas limp�ace <br /> D:shwasher _ Gasrange <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(servicePoaqmop/etc.) _ Exhaustlan <br /> Backflowpreventer _ Heatpump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Greasc Irap Woodstovc <br /> Roof drains Other <br /> Other - <br /> CITY OF BVERETT LOCAL SALES TA7C CODE IS 3105 <br /> I hereby ceritify that I have read and examined Ihis application anA know the same to be Ime and wrrecl. All provisions ol laws and <br /> ordinaces govemin�this type of work will be complied with whether speci(ied herein or nol.The granting of a permit does noi presume <br /> Io give authority lo violale or cancel the provision ol any other slate or local law regulaling construction or the perlormance of <br /> construction.Th I am authorized by the owner oi this propeAy to pedorm Ihe work tor which application is made and I comply with the <br /> Stale CoNr t w 182 .W and 296.200 WAC. ._ / � <br /> ��� 0 <br /> SignaWre o + e o racloVAuthorized Agenl Date <br /> �� <br />