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i <br /> PERMIT APPLICATION <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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM J'Z— �C� —O � <br /> SITE ADDRESS ��f oa �-1I2�feen� W°-y PARCEL TAX I.D.# PERMIT# <br /> �vere�tF 4�/� ao Sa7�a-oo8' <br /> LEGAL LOT N0. BLOCK TRACT OR SUBOIVISION# <br /> �ESC. <br /> OWNER AUDRESS GITY/ZIP PHONE <br /> �av�d �'r.»� 4L'I n,. �-vu9rezn, W"j� �oer�N GUA �d'�-o5L �101�'- 7Sa -�-'lS', <br /> � <br /> TENANT NAME I CONTACT FOR PERMIT PHONE (/�-J'- 7!�'J- e�J6 D <br /> DCL V� [` IL..%w� I E-MAILISPS{-Si9� 9//� �alloo,G <br /> CONTRACTOR ADDRESS CITYIZIP PHON <br /> Gvl, �Fe S��'m U.f /k ../ <br /> CONTR.LICENSE# �pr 9�f 3 f�� ���1� I'�W�� "7Q `�ill�liJrucl CJA ��u)� �1.t- 7�']-�'/ .o <br /> USE OF BUIL�ING HEAT SOURCE CONTRf;CT PRICE OF WORK <br /> Eleclric Gas Olher <br /> WORK DESCRIPTION <br /> �o�J 4� sjF WciN s ��m , l�ns'-�anc�;�n� _ <br /> PLUM9I�G MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF F�IXTURE OR ITEM <br /> Toilet A/C-air handling unils <br /> Bathlub Forced air systems <br /> Lavatory(wasli basin) _ Gas piping <br /> Shower V6'ater lieater <br /> Kitchen sink&disposal Gas fireplace <br /> Di,hwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Waler healer _ Range hood <br />� Sink(service/barlmopletc.) _ Exhaust fan <br /> Backllow preventer Heal pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeralion <br /> Grease tr2p Woodslove <br /> Roof drains Other <br /> Ofher <br /> CITY QF EVERETT LOCAL SALES TFJ(CODE IS 3105 <br /> I hereby cerilify lhat I have read and examined this applicalion and know the same lo be true and correcL All provisions of laws and <br /> ordinaces goveming this type o(work will be complied wilh whelher specified herein or nol.The granling of a permit dces nol presume <br /> lo give aulhority to violate or cancel Ihe provision of any olher state or local law rec�ulating construclion or lhe performance of <br /> construclion.That I am authorized by the owner of lhis property lo perform lhe work for which application is made and I comply wilh the <br /> Stale Contraclors Law 18.27 RCW and 296.200 WAC. <br /> � ��_ ��_ ��^ <br /> �� � <br /> Signalure o�OwnedConlractodAuthorized Agenl Dale �7 � <br /> /Z <br />