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P�RMIT APPLICATI(�N <br /> CITY OF EVERETT PERMIT SERVICES ��,1�� <br /> 32U0 CEDAR STREFT, EVERETT, WA 98201 �'1 <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.* PERMIT t <br /> Ill �Sl � r..u-v� wa ocoll�oo <br /> LEGA L07N0. B OCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> TENANT NAME CONT CT FOR PERMIT P ONE <br /> '��.lo %G�ar '�¢-���a�,x �i�-I'1�-� ��- 6`63— /y/� <br /> CONTRACTOR/��e� �''-)� DR SS CITY/ZIP PHONE <br /> l• �5 �. Go..K�lr.v `/f. �'e«ts�tc Rf�r9�f J-�lo - 'JJst -��J- <br /> CONTR.LICENSE S /_ n ���G G �� A �� <br /> (i{ Y• ✓ 1 <br /> USE OF BUILDING HEAT SOURCE CONT CT PRICE OF WORK <br /> ���fikJ�/'R� _ElecMc ,�Gas_Other �j �� (7 <br /> WORKDESCRIPTION ��y, �/ O,� ��,�L�„� -(t,� Z Naot� `754-�'+�/ <br /> �.a-h.�.v�r �.�,�, i+�lc.,� �/io �%' / � �/a� l�vca` �(ia✓� , <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet AIC—air handling unils <br /> _ Bathtub � Forced air systems <br /> Lavatory(wash basin) Gas pipfng <br /> Shower Water heater <br /> Kilchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater � Range hood <br /> _ Sink(service/bar/mop/elc.) � Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeradon <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <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 provlsions of laws and <br /> ordinaces governine�this type of work will be complied with whether specified herein or not.The granting of a permil does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construcUon or the perfortna�ce of <br /> construction.That I thorized b wner of this property to pertorm the work for which application is made and I comply with the <br /> State Contrac aw 1 d"296.200 WAC. <br /> /� �� <br /> Si ture of wner/ actor/Authorized Agent ate �N <br /> Y �- <br />