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� <br /> PERMIT APPLIGATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERE'R', WA 98201 <br /> 425-257-8810—FAX 425-257-8657—www.everettwa.org <br /> APPLICATIONS ARE ACCEP7ED FROM 8 AM TO 4 PM <br /> SI�T ADDRES PARCEL TAX I.D.# PERMIT# <br /> ��L. � C�G U'� 19�� U��3 16.2�G `7c�n 5c�o�( c��{— <br /> LEGAL LOTNO. BL CK TRACT <br /> DESC. <br /> OWNER ADDRE55 CITYlZIP PHONE <br /> 15013 lMr.��,Ar� ����" � s 7 �4 �' I <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> � tk /� � � �U�re"1-F �1�/�'I �M 1 �cc� 4�S- cY_..Z2 � 2 ��� <br /> CONTRACTOR G� y�� ADDRESS p �.CITYIZIP PHONE <br /> �C /��9 � `+"�✓�/ g/ � c� N�>/ l\�v���cY4� S 2 ?�2C��� <br /> CONTR.LIr,ENSE# � <br /> S/r �1 � �4� �2U1f3 <br /> USE O� HEAT SOURCE CONTRACT PRICE OF WORK <br /> � �� , _Electnc _Gas_Other ICj� �f b(�, ��� <br /> WORK DESCRIPTION �� 5—� � L -y- <br /> �-�'C l. C, Z��J l.lv�. lv ,/PCf�4� <br /> j� �� SLL�n^�-� , <br /> -F'- S �7 �-L ! c.i.�t GL cti1 o u.�t� �.us�� w•� G` s c �,.( <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR IiEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet AIC-air handling units <br /> Dathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(servicelbarlmop/etc.) Exhausi fan <br /> 8ackflow preventer Heat pump <br /> Unnal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other - <br /> Other <br /> CITY OF EVERETT LOCAL SAIES TAX CODE IS 5105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions ot laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or not.The granting of a permil does not presume <br /> lo give authoriry to violate or cancel the provision of any other state or local law regulating ccnstruction or the pertortnance of <br /> cons ction. Thai I am authonzed by the owner of this property to perform the work for which application is made and I comp�y with the <br /> Stal Contrado a t .27 RCW and 296.200 WAC. <br /> Sign � re of OwnerlCon c or/Authonze Agent Da� <br /> i� <br />