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F�RMIT APPLICATI�,N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-7_57-8810— 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 /> 0�� `� Q� oo�Fb�'000 zo23� j'� 91a - O�/ <br /> LEGAL LOT N0. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PNONE <br /> v,�+��. �����r�� � <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> E-MAIL <br /> c N R �� C�-a iti(t,t��� -�S�MC �3� irv PH �2S-77� — <br /> � Ly�n�nlno� 9�{ro 96� <br /> CONTR.LICENSE# <br /> �flGL�Gn�0`�'�D i <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE Of WORK <br /> � . � yU <br /> �S � � _Electric �Gas_Olher � <br /> WORK DESCRIPTION �,�L,p � -�''�yy� �, /�,IE�—� �� ���- !' '�� `-'� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilcl A/C-air handling unils <br /> Balhtub Forced air syslems <br /> Lavalory(wash basin) ,,_ Gas piping <br /> Shower Water healer <br /> Kitchen aink& disposal Gas tirep�ace <br /> Dishwashcr Gasrange <br /> Clothes washer Ciolhes dryer <br /> Waler heater Range hood <br /> Sink(service/bar/mop/etc.) _ Exhaust lan <br /> Backllow prevenler _ Heal pump <br /> Urinal Unit heater <br /> Drinkinc� Founlain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease trap Woodslove <br /> Rool drains Other <br /> Olhar <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify ihal I have read and examined lhis application and know lhe same to be true and correct All provisions of laws and <br /> ordinaces governing ihis lype of work will be complied with whelher spaci(iea herein or not.The granting of a permil does nol presume <br /> to give aulhoriry to violate or cancel the provislon ol any olher state or�ocal law regulating consWction or the periormance of <br /> coqs�ruclion.Thal I am aulhorized by t owner of lhis property lo per(orm the work for which application is made and I comply wilh the <br /> Slat ontract 1827 W 96.200 WAC. <br /> Cf�t� ��,c,c.� �__ � �-�zx��9 <br /> Signature wnedCoNractor/Authorized Agent D e <br />