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PEKMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> S S ��r'�c. dj-�!E 6l0 G 3-00 J <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> �( �d��w Chc.-ry ,7f/S f�`dqy AvF i�,.��c� qdad� zo� `lyJ� JGC 6 <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> ��• ca.�c•� P��ns,�,� s.u. yc.r yiB-�aoy <br /> CONTRACTOR ADORESS CITY2IP PHONE <br /> /�lew Lance,�FJ P�4n.b��� 'Z�G' , 4i �QdX ���� E✓vc*f �Ll! <br /> CONTR.LICENSE#N� w G aPP Q I � M r y:,r ri�� 3�d4 <br /> ii �r <br /> USE OF BUILDING I � HEAT SOURCE I CONTRACT PRICE OF WORK <br /> yo n« Electric Gas Other �� dcSo, oG <br /> WORK DESCRIPTION <br /> Rc�v�u G� �f w4f"' �`"`N � f��� .Z�c M<-��c.- fj d.l a�K.f ti ✓�S 4 4'i <br /> � �� �«.J�7 ,Or 4 i I� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet AfC—air handling unils <br /> Balhtub Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Waler heater <br /> Kitchen sink 8 disposal _ Gas fireplaco <br /> �_ Dishwasher _ Gas range <br /> � Clothes washer _ Clothes dryer <br /> �_ Waler heater _ Range hood <br /> Sink(service/bar/mop/etc.) _ Exhaust fan <br /> Backflow prevenler _ Heatpump <br /> Urinal Unil heater <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains _ Other <br /> J_ Olher SG c �`'��`'��' _ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceritify thal I have read and examined Ihis applicalion and know lhe same to be lrue and correct. A�I provisions of laws and <br /> ordinaces governing this type o(work will be complied wilh whether specified herein or not.The granting ot a permit does not presume <br /> to give authority lo violale or cancel the provision of any olher stale or local Iaw reguiating construction or the performance of <br /> construclion.Thal i am aulhorized by lhe owner of this property to peAorm the work for which applicalion is made and I cor�ply wilh the <br /> State Conlractors Law 1827 RCW and 296200 WAC. <br /> �,� .�f---� �� J .� o 0 6 <br /> Sig ure of Owner/Conlractor/Au�honzed Agent Date <br />