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I0 � �3 -0 <br /> PcRMIT APPLICATI(�N <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 APPUCATIONS ARE ACCEPTED fROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# ERMIT# <br /> �c �i.-.C3Y Av�NV�- oD4� 1 cv2�}oZ-7�a �`7�� � <br /> LEGA LOT NO. BIACK TRACT <br /> DESC. �oYr. oi 2�� �Zy_ <br /> n.u.. nti -7$ 29 <br /> OWNER ADDRESS CITY2IP PHONE <br /> �v��T�r S�'n�P+1oN�I 27ot3 Go�iSY �4vE.. Gv��.ti'T,'15zn1 Cqzs�-257-833�... <br /> TENANT NAME CONTACT FOR P[RMIT PHONE <br /> EVF-�T-( SYM7��NY GI-Ih_i�� 1��i-� �A2S�- ZS� - •�'3Cv'� <br /> CONTRACTOR ADDRESS CIN21P PHONE <br /> CONTR.LICENSE il <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> �v���T-t' SY�^PHbNY _ElecUic _Gas_Olher �Z� �TB. 00 <br /> WORK DESCRIPT�ON <br /> Pst��rr,���.Uv 'Flz��s'i�P�Nc� /✓��TA,t_ L�'rT�tZS 'i'o 1'0� o� M�AL !/�nloPy <br /> j�l)7 - �,GG��,�,ynt9���� <br /> PLUMBING MECHANICAL <br /> NO. TYP[OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling uoits <br /> �athtub Forced air syslems <br /> Lavalory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher � Gas rango <br /> Clolhes washer Clolhes dryer <br /> Laundry tray Range hood <br /> Sink(servico/barlmop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountaln Boiler <br /> Floor drain Refrigeration <br /> Grease lrap Woodstove <br /> Roo(drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify thal I have read and examined this applicalien and know Ihe same fo be lrue and correct. All prcvisions of laws and <br /> ordinaces goveming this typo of work will be complied wilh whether specified herein or noL The granting of a permil does not presume <br /> to givo aulhority to viotalo or cancel lho provision of any otiier state or Iocai law regulating wnstruction or the pedortnance of <br /> construclion.That 1 am aulhori2ed by the owner of lhis propeRy to perform lhe work for which applicalion is made and I comply wilh the <br /> Slate Coniractors law 18.27 RCW and 296.200 WAC. <br /> ��n.-_-___ f1J✓ ���3�C -�-� <br /> Signature of Owner/CoNrac /A orized Agent Date I/ <br /> �YZ <br />