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:� -� <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 I <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 3 --� `-�� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 4 �:d� �a•n,n`i��,cst sr ko�y�o z-o��' <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> {LG�/���� /L�n.�f_A i D <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> CONTRACTOR �����NS�i�J G�A,t(r. ADDRESS qTY21P PHONE <br /> z93d o iz ,ni �4��= .�.e' /3[•��/Vu3 �Y� z. <br /> CONTRUCENSEA �Q����N/7�272[ t �A����L���� <br /> ��d'2z � <br /> USE OF BUILDING — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> S �� �` Eledric Gas_Other 3 7�$ <br /> WORK DESCRIPTION <br /> /.�i y i:9 t< (=//-'t= S f�K.:iv.�Lt 'J' .N Nl:yt.. � �_.� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF PI%TURE OR ITEM � � <br /> Toilet AIC-air handliny uni � ' . , <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shovrer Water heater <br /> Kilchen sink&disposal _ Gas fireptace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> _ Laundry lray _ Range hood <br /> Sink(servicelbar/mopletc.) _ Ezhausi fan <br /> BaGcOow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodsrove <br /> Roof drains Other <br /> Other <br /> '1/ S l�iA.'K4-'.ZS <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J705 <br /> I hereby ceritiy thal I have read and examined this application and know lhe same to be lrue and corred. All provisions o(laws and <br /> ordinaces goveming this type oF vrork will be complied with vAiether specified herein or not.The granting of a permit dces not presume <br /> to give aulhority to violate or cancel the provision of any other state or Iocai law regulating conslruction or the perTormance ot <br /> construction.Thal I am authorized by lhe owner of this property lo perform lho work(or which application is made and I comply with the <br /> State Conlraclors Law 1827 RCW and 200 WAC. <br /> .—��. i ��-� � �zi� ��o�. <br /> SigTfalure of Own rlContractodAuthonzed Agent Date <br /> I%'C_ <br />