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P�RMIT APPLICATIC�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERElT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# P !JIIT# <br /> 3� �0 �ol�- A�e Ys ., aa o2 0� _ �' ' <br /> IEGA LOTNO. BLOCKn TRACT <br /> DESC. �r Sii.j4 /rst/S�f �.. r/rrr/ `�� y�� <br /> OWNER ADORESS CITYlZIP PHONE <br /> � vc. r��pu��r� CCC ?��' c�l�,r /��� �uercN�t�/1 9L^ul ��2s�2s2 393� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> S�?��c� /� S���c9er 5�,'� �J s��r���� �fzs-Z.Yz s'�3� <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> U/s�.ti nn�� U�soN �HCavq�.+g �uCti< �7/4 kuerctl, G^�R 94U3 L�2S. t�� ���� <br /> CONTR.LICENSE N <br /> Tl�k� ,� GU(iG`iOs'( <br /> USE OF BUILDING HEAT SOURCE I CONTRAC7 PRICE OF WORK <br /> Q�� v�,N���� _Eleciric X Gas_Other <br /> WORK DESCRIPTION <br /> �e14`uli ��liv u� /JG'1�/l1��"p <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTIIRE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilet i�1C—air handling units <br /> � Bathtub Forced air systems <br /> i Lavatory(wash basin) _j_ Gas piping <br /> Shower � Water heater <br /> _L Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryer <br /> Laundry trey Range hood <br /> Sink(sen�ice/badmopletcJ � E�chaust fan <br /> Backflow prevenler Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> i Fioor drain Refrigeration <br /> Grease trap �— Woodstove <br /> 1 Roof drains Other_ <br /> Other <br /> I <br /> � CITY OF EVERETT LOCAL SALES TAX CODE IS :105 <br /> � I hereby ceriti(y that I have read and examined this application and know the same to be t:ue and correct. All provisions of laws and <br /> ordinaces goveming ihis type of work will be complied with whether specified herein or not.The grantlng of a permit does not presume <br /> I to give authoriry to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> construction. That I am authonzed by the owner of thls property to perform the work fer which zpplication is made and I comply with the <br /> Slate Con/kre1ct s L 18.27 RCW and 296.200 WAC. <br /> I I ��A J�'� �/2LIaS <br /> Signatur of w nContractonAutfionzed Agent Date <br />