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I <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVlCES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810–FAX 425-257-8857–www.everettwa.org <br /> �� S APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �Z —� 3,��� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT If <br /> ��-` co1.3y �Pv �oi � -cx�g <br /> LEGA LO�NO. BLOCK TRACT OR SUBDIVISION I{ <br /> DESC. <br /> OWNER ADDRESS CITYIZiP PHONE <br /> �21�1 i o�.l 1.�. �A NK �/cro Ct�c.� �o�R N,�r� s; s.�� FRw,,+�.��� ,Q�A q4�o1 <br /> TENANT NAME CONTACT FOR PERMIT PHONE S\O 71 S S�)$�f� <br /> U I��\ O N Q�AN �\ I ` `iCa`l'r��p 4`v�-a\N\ E-MAIL <br /> �A4�OW S; G-N C�Q . /OS� �-\t��s `AV o�P`�L�PHn ,C�A �"�bol <br /> CONTR.LICENSE#, ^ ��0� ��Q/- �� h2 �d/^ J <br /> Y� p // <br /> USE OF BUILDING I HEAT SOURCE O C ICE OF WORK <br />' �� M �L I _Electric _Gas_Other • <br /> WORK DESCRIPTION , �� � � ;����-L w;��� <br /> tiP�-�Pc��. �.'Y��S � � M 4 1-�0 MZ��i�- <br /> �71y�o� 3,AN.�< . � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling ucils <br /> Bathlub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposel Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink (servicelbar/mop/etc.) Exhausl(an <br /> �ackflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> Roor drain Refrigeration <br /> Grease irap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify ihat I have read and ezamined this application and know the same to be true and correct. All provisions of laws and <br /> ordinances governing this type of work will be complied wilh whether specifed herein or nol.The granting o(a permit does nol presume <br /> to ly to violate or cancel lhe provision of any olher state or local law regula�ing construclion or ihe periormance af <br /> c nstruction. hat I ai uth rized by�he owner of Ihis property lo perform the work(or which application is made and I comply with lhe <br /> S te Co.t aclors L 18.27 RCW and 296.200 WAC. <br /> \ = � � 'Z-`-� ' ��o <br /> Signature of OwnedCon raclor/Authorized Agent Date �/ <br /> Z <br />