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, PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES �I��b I <br /> 3200 CEDAR STREET, EVERETT, WA 98201 I <br /> 425-257-8810—FAX 425-257-8857—www.everetlwa.org �—' <br /> / �APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � <br /> SITE ADDRESS PARCEL TAX I.D.� F�T�� � , <br /> � �ooyyz9 aoo�oo �b � - a/ � <br /> LEGA LOT NO. BLOCK TRACT � <br /> oesc. �J� o �I 12 3 Oo3 D'� � <br /> OWNER ADDRESS CITYIZIP PHONE <br /> �//�.P��Pi�I� �ieDpE"�oT/SS LLG� , vr0?�7 TfYL /�Y�` AI/E �8�'� U+2 9J7oZ <br /> TENANTNAME . CONTACTFORPERMR PHONE <br /> ��-S ��r� I �j LL Z,S3 --�SY'�yYY Gr //8 <br /> CONTRACTOR 6AJ(�.S S EMIS ADDRESS CITY2IP PHONE ��/, <br /> SrA� AC�oEs L 9�l aw $35'iu. GbM`/�AL /�D�. ,r6NC zs,-�' � <br /> CONTR.LICENSE k BB� g8'O ,,� Z"30�J <br /> 4�5�4 �t�� �' '' - � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK i <br /> D� /�� � /j1 r��/� I —Eledric �Gas_Other �� �.lJ 7 • S� I <br /> /L K /�-� <br /> WORK DESCRIPTION ���A� �(.¢liJ ��'/�K F�WK EX�S ti.�G G- �`OA/ �C ��`S <br /> G�MTS C27 'To FEEO N6W R���'��• � •�-+C'7�9LG iVEW Y- ;7aa A�' IZ,zFfGP <br /> NNIT• �uGt 'Cb /�a�GrA�I+�-G �?�/[ C�� . <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR REM <br /> Toilet ,_ AIC-air handling units <br /> Bathtub Forced air systems <br /> _ Lavatory(wash basin) � Gas piping <br /> Shower _ Water heater <br /> Kitchen sink&disposal _ Gas fireplace I <br /> Dishwasher _ Gas range I A /�-�� <br /> Clothes washer _ Clothes dryer nU ri� � ) <br /> Laundry tray _ Range hood �.l <br /> Sink(service/badmop/etc.) _ Exhaust fan <br /> Backflow preventer _ Heat pump /� � <br /> Urinal _ Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain _ Re(rigeraGon <br /> Grease trap _ Woodstove <br /> Roof drains _ Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and c:orcect. All provisions of laws and <br /> ordinaces governing this type of work will be comptied with whether specified herein or not.The gr.anling of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating constru<:tion or lhe performa�ce oi <br /> consiruction.That I am authorized by the owner of this property to perform the work for which application is made and I wmply with the <br /> Slate Contractors Law 1827 RCW and 296.200 WAC. � <br /> o�/D(o <br /> SignaWre of OwnedContraclodAuthonzed Agent a��— <br />