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�cRMIT APPLICATI�N � <br /> CITY OF EVERETT PERMIT SERVICES �o���I <br /> 3200 CEDAR S` -ET, EVERETT,WA 98201 <br /> 425-257-8810- FAX _5-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �{�/�7 - 003 <br /> SITE ADDRESS C y�� a I�, ' PAP.CEL TAX LD.# PERMIT N <br /> 1���� /�EEw Ar po��z4003o�%'0� <br /> LEGA LOTNO. BLOCK TRACi <br /> DESC. <br /> OWNER ADDRESS CITY/LIP PHONE <br /> � dE�C,G�Y /�%WQ�%iE�' Z �z- '�1 /� Vc(�t'/Z ,A✓C �/ov �V6'IZ677 <br /> TENANT NAME Z A.� -7H/�.� � �}y��NT,.�CT FOR PERMIT PHONE <br /> Sv,DA2�IT TiACK,4Q��- /�o�- �r-/i.�/ �6 3 S3 �i� .o <br /> CONTRACTOR w F S'"� (� � s/ /" F-�'/'G�t/ � �i��C� /�� 6'� � PH�G 3 r 3�� � <br /> CONTR.LICENSE ii <br /> W �ST � P.� oa7Po r,�.���, �✓�r," w,a ti.�o�z <br /> USE OF BUILDING I -- HEAT SOURCE I CONTRACT PRICE OF WORK <br /> i� <br /> Electric � Gas Other �:�c Q�� <br /> WORK DESCRIPTION <br /> f�rl�v� DE /�Lv.�t�3in/G , GA-S �o ,zEs��d,�,�nJ�" <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. iYPE OF FU(7URE OR ITEM <br /> ?�- Toilet _ A/C—air handling units <br /> Bathtub Forced air systems <br /> � Lavatory(wash basin) ,1_ Gas piping <br /> Shower L, Waterheater <br /> Kitchen sink�disposal Gas fireplace <br /> _L Dishwasher ,�, Gas range <br /> Clothes washer � Clothes dryer � <br /> �� Water heater � � Range hood � �,� <br /> Sink(servicelbar/mop/elc.) � _ Exhaustfan � <br /> � BackFlow prevenler _ Heat pump ��� <br /> _� Urinal _ Unit heater <br /> Drink(ng Fountain Boiler <br /> � Floor drain Retrigeration <br /> _� Grease trap Woodstove <br /> Roof drains Z Other J7EE/� y��Z <br /> Other � (�/l�i!�/Z <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby ceritiry that I have read and examined this application and know the same to be true and correct. All provisions oi laws and <br /> ordinaces�overning this type of wcrk will be complied wilh whether specified herein or not.The granHng of a pertnit does not presume <br /> lo give authorily to violate or cancel the provision of a�y other state or local law regulaGng construction or the perfortnance of <br /> construction.That I am aulhorized by the owner of this property to perfortn the work for which application is made and I comply wfth the <br /> State Contractors Law 18.27 RCW and/2,'�6.200 WAC. <br /> ,���"�— i v- z S- 0 6 <br /> SignaWre of Owne Conlractor/Au orized Agent Date <br />