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i <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERET�, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM s-U �{ -O 7 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> �/JZ�� �'������f �� F�os t�i ynooc� L�oo ��05- <br /> LEGAL LOT NU. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE S7j�2S3-�� G.: <br /> STAi�Lii.{1 Nc. - 5 vv ST�n G � �t�u-� _ f,E..9+Yi rnr G J✓�wr, w�A a /7v 2 <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> Sr�-nLe L t��d �/���,� 3Go- 7.5-7-6�D`i <br /> CONTRACTOR ADDnRESS CITY/ZIP PHONE <br /> .� if /J�Z���c.f-! �7// !/v,e.� �,E�c�.c_. l��.c%�.f/r�-/ `�vL3 j <br /> CONTR.LICENSE# <br /> 3 60 -�s 7-6�0 - <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> /� �� � / _ElecVic _Gas_Olher L Z -�1'�S�'. U6 <br /> K1. <br /> WORK OESCRIPTION � � <br /> 2�u 6��- �,� /�/u«�,,,�� � ,�,µ., <br /> PLUMBING MFCHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilet PJC-air handling unils <br /> BalhWb Forced air systems <br /> ..Z Lavatory(wash basin) _ Gas piping <br /> Shower W ater heater <br /> I Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Cbthes washer Clothes dryer <br /> Laundry lray _ Range hood <br /> i Sink(service/bar/mop/etc.) _ Exhausl fan <br /> Back(low preventer _ Heal pump <br /> I Urinal Unil heater <br /> I Drinking Founlain _ Boiler <br /> � Floor drain _ Refrigera�ion <br /> Grease lrap _ Woodslove <br /> I Roofdrains - Q+L:,r.n� i-.��i:�Hy _ Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> I hereby cerilify lhal I have read and examined lhis appli�alion and know lhe same to be true and wrrecl All pmvisions of laws and <br /> ordinaces goveming lhis type of work v✓ill be complisd wilh whether specifed herein or nol.The granling of a permit does nol presume <br /> lo give authority to violate or cancel the provision of any other slate or local law regulating consWction or lhe performance of <br /> construclio Thal� am authorized by lhe owner of lhis property lo pedorm the work for which applicalion is made and I comply wi�"lhe <br /> Slale Cor�t clors Law 18.27 RCW and 296.200 WAC. <br /> �//G'� <br /> Signature of OwnedContrectorlAulhorized Agent Date <br /> �j <br />