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PERMIT APPLICATION <br /> CITY OF EVERET'T PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-vwvw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX 1.D.# PERMIT X G(OG,�j <br /> fz. Q � �fj('c-G'> ,— .D� e�vy�/9�ib� �ov sov <br /> � <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESG j [� J ���-Si PA2� .� <br /> OWNER ADDRESS CITY2IP PHONE �.Lf- ZS�" <br /> ���F f �,vni�t �1cu .N-�s -�4vi 1=z�2e5,- D.e �„_a�� 9°�z�3 _yR�r <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> ��J DZ56n� 42-� �'�� S�s2 <br /> CONTRACTOR F;,���7C �A�Gt.rj !,U ADDRESS CITY2IP PHONE St2j stag y'J)"1 <br /> z7zL ��ce� A-vc F�tc¢� i,..a y�zoi <br /> CONTR.UCENSE# ,��C�FGI U'�o'�N <br /> USE OF BUILDING — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �vD�� . / 2 2ao. �� <br /> ���G(% Electnc _Gas_Other <br /> WORK DESCRIPTION Coi✓S j/Lu[j �I�C �42 �d/L4�c;� �O l�TJGN 7�o f{��,G— <br /> � <br /> PLUMBING.- MECHANICAL <br /> / <br /> NO. TYPE OF FIXTUREOR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet A/C–air handling unils <br /> BathWb Forced air systems <br /> Lavatory(wash i;�sin) _ Gas piping <br /> Shower Waler heater <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Waler heater Range hood <br /> Sink(serv(ce/badmopletc.) _ Exhaustfan <br /> Backflow prevenler _ Heal pump <br /> Urinal Unit heater <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeration <br /> Grease lrap _ Woodstove <br /> Ftoof 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 provisions of laws and <br /> ordinaces�overning this type of work will be complied wilh whether specified herein or nol.The granting of a permit does not presume <br /> lo give aulhority to violate or cancel the provision of any olher stale or local law regutating conslruction or the performance of <br /> construction.That I am authorized by the owner of this prope:ly to pertorm the work for which application is made and I wmply with the <br /> State Contraclors Law 18.27 RCW and 296200 WAC. � <br /> ��a <br /> SignaWre of OwnedConlractorlAulhorized Agent Date <br />