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�RMIT AF`PLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES ����S ) ���` <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTEO FROM 8 AM TO 4 PM / <br /> i <br /> SITE ADDRESS PARCEL TAX I.D.* PE R <br /> / CUL`-'IZG/���/ !,r QO O 0�70 0 "L� <br /> LEGA LOT N0. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> Ev�2l�ie�Y L ,��-27its Zd'zg �e vc���2A�'� �oo �v�7> <br /> TENANT NAME �y�L�� CONTACT FOR PERMR PHONE <br /> 5����i 7I�CKsi�2o�✓w Tl�a.��l-S G 1 �3 - q� 3 - g5o <br /> CONTRACTOR ADDRESS CITY2IP PHON � <br /> �✓�ST Co,A ST PP�s��2rY �zS�a' ti� J6 � �1 3 73��ao <br /> CONTR.UCENSE N w�.ST �P,y o a �P� W�����jGL�"� G/A <br /> �`�O-7 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PWCE OF WORK <br /> /�eS'rp+L2i�� __Electric Y Gas_Olher p S0�(�'� <br /> WORK DESCRIPTION <br /> �(/I �' i(/�L✓ G✓A�GG S �- /��S'1��,'`'t l <br /> h��� < <c s . PL,i�r/.3�N�. .,qa� !�.q-S , <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> �2 Toilet _ A,'C—air handling units <br /> Bathtub Forced air systems <br /> Lavalory(wash basin) � Gas pipfng <br /> Showe.r � Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> ' hwasher Gas range <br /> Clo es washer lothes dryer <br /> � Wate eater Z ge hood <br /> ?�_ Sink(se ice/hadmop/elcJ _L Exh st fan <br /> Backflow p venter _ Heat p <br /> � Urinal Unit hea r <br /> Drinking Founta� Boiler <br /> � Floor drain _ Retrigeration <br /> � Greasetrap Woodstove �2Y� <br /> Rooi drains T Olher <br /> = Other \ � G E • <br /> _L <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether speci4ed herein or not.The granling of a pertnit does not presume <br /> to give authority to violate or cancel the provision of any other stale or local law regulating cor�structlon or the peAormance of <br /> construction.That I am authorized by the owner of this property to peKortn the work for which applica�on is made and I�romply wNh the <br /> St�le Contra�rs Law 1827 RC1p and 296200 WAC. <br /> 6'- Z6� �� <br /> Slgnal re of OwnedConlrectodAuthorized Agent Dale <br /> ��Z <br />