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� � <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 -DEBIT�CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT <br /> Y7/8 EVEQ.4LiGN wqy &.�cerr Wa Ob58/90000 7`/� D �� ,�_`�j "� (� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. J`�.�>-7L•77 7Y b Do O-oo Sek�.h N�wa /�oo <br /> OWNER ADDRE55 CITY2IP PHONE ,y�s_y�-�_ 9i � <br /> f��/CINaq; e � <✓cwe-T/ `/808 c✓,-arecF�✓�y �✓Ec�rr �C✓A Jr81a3 <br /> . <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> Nyuno�ac < +l Eve.�r�r Gz.Fi�- �C{' EnZ4FO�K 3Go- S�ZS'- 87�0 <br /> CONTRACTOR ADDRESS CIN2'1/P / PHONE <br /> GRCST SN� , /�. 0. /.je+c .2/S!i /�'Ou�f�✓i2NCM .�. 6o -yyy_ S� OL <br /> CONTR.LICENSE GYE�T�� O $�]J / 9 E�z �'� <br /> �' � �- O Co <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> g, }�p 0 <br /> Elecinc V�Gas Olher �� �� <br /> WORK D-SCRIPTION , • <br /> /oo (3 f n/an/ tSE��,.rr� w.���s u. �y: 7.7rf. w�//��S:n�l <br /> �un � <br /> � � 3ose i✓ooc/ iKad'naozg Z�p,/tc.- c��-,ocT.�� <br /> AND 56�r.G L.iyL, ! F�X�/v-•-=`, <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEA1 NO. TYFE OF FIXTURE OR ITEM <br /> � Toilet A/C-airhandlingunils <br /> Balhtub Forced air syslems <br /> �— Lavatory(wash basin) Gas piping <br /> = Shewer Water heater <br /> Kilchen sink&disposal Gas freplace <br /> Dishwasher Gas range <br /> Clothes washer Clofhes dryer <br /> Laundry tray Range hood <br /> Sink(service/bar/mopletc.) L Exhaust fan <br /> � Backflow preventer Heat pump <br /> Urinal � Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease lrap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I have read and examined this application and know th:same to be irue and correcL All provisions ol iaws an� <br /> ordinaces goveming this type of work will be complied with whether specified herein or nol.The granling of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or loral law regulating construction or lhe performance of <br /> construclion.Thal I am authorized by the owner oi lhis property to perform the work for which application is made and I comply with the <br /> State Contrectors Law 18.27 RCW and:86.2D0 WAC. <br /> ���-�����/�'i:�✓;.z .�3- z-�-s oe s -� <br /> Signature ot Own2N�nntractor/Fwthonzed Agent Date �/� <br />