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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, [VERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-vnvw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � Z .�/S '-'tf� <br /> SITE ADDRESS PARCE TAX I.D.# P RMIT tl <br /> �%S36 Col Av� �vr.P.�rr WQ 9 bO�U ��pono�y /�'o o �(�,//' C� �= <br /> LEGAL LOiNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRE55 CITYIZIP PHONE �V�1 <br /> J <br /> S��%j�4 S�/-�in� �1�36 Cc�[.�3V A�c �UEtFrT (,�,� 98��3 93�-�o��g <br /> TENANT NAME CONiACT FOR PERMIT PHONE <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# � ���� �'�s -r'-G � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �.tio-1 *��,�C '�.isLC���- /' <br /> r _ElecUic _Gas�Other Vi/ <br /> WORK DESCRIPTION <br /> 9 aWf.OS�,,fl c-� �s�q6�E Co�v.�,�r� 7a Givha 5"P.�c� . ,w uta.,Uzi 70 <br /> Ou75�py o "r //�//J',� �.t,x�IG � 04TSipa c�/,•-, ;r�sion5 . �PA-,e,��le- 5?4G� <br /> s �� r E N�s� , <br /> PLUMBING^ MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 4 Toilel A/C—air handling units <br /> OalhWb Forced air syslems <br /> � Lavalory(wash basin) _ Gas piping <br /> � Shower _ Water heater <br /> Kitchen sink 8 disposal _ Gas fireplaco <br /> Dishwaslier Gas rango <br /> Clothes washer Clothcs dryer <br /> Water healer Ranc�e hood <br /> Sink(service/bar/mop/etc.) � Exhaust fan <br /> 7 Backflow prevenler _ Heat pump <br /> � Urinal _ Unit healer <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeralion <br /> Greaso lrap Woodstove <br /> Roo(drains � Other {/EAT ,Z£6KT�G <br /> � Olher t'�G �cNis _ _'�4r o: ,�.trsri�� <br /> — NEa��O/G-. <br /> CITY OF EVERETT IOCAL SALES TAX CODE IS 3105 <br /> I here6y cerilify thal I have read and examined this applicalion and know the same to be true and correcL All provisions of laws and <br /> ordinaces goveming this type oi work will be complied with whether specifed herein or not.The granling of a permit does not presume <br /> lo give aulhonty to violate or cancel tha provision of any oiher slate or local law regulaling wnslruction or the pertormance of <br /> conslruction.That I am aulhorized by Ihe owner of this property to pertorm lhe work(or which applicalion is made and I comply wilh Ihe <br /> Stale Contraclors Law 18.27 RCW and 296.200 WAC. <br /> Gr-(s'�J ,j �y�C[.?� '/7'�Z-�-ww <br /> Signature o Owner onlraclor.�Authonzed Agenl Dale <br /> ��z <br />