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PERMIT APPLICATIOnI <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 �l�R� � ��a PARCEL TAX I.D.# PERMIT/t <br /> �� �i�1 ,' i D�j:�� oonno����= C_<�='��� _' <br /> LEGA LOTNO BLOCK �TRAyCT -� <br /> DESC. � fc!�IR [Gf� �l�NOR L/�l/�SiON �J <br /> OWNER ADDRESS CITY2IP PHONE <br /> ��c,rf�.e�o %aa4c�e�� 5��1i2 Cc,zb�;y i�R �'�P.cE� yz� =Si3 a3S�. <br /> TENANT NAME � � CONTACT FOR PERMIT PHONE <br /> I L��if IcNC'rtSlllofZTN' `�1uADF �I(�£'i'SJ 7�ia�I —Sc�J � <br /> CONTRACTOR �SG�!{D� ' Uu��C�Pi25 11�./L? ADURESS CITY2IP PHONE � > >;,t7 <br /> 7%G?� GSr''/��� Sf. S�/rvhom,'sA <br /> �15-�3� `.. <br /> CONTR.LICENSE# 9 8�9 O <br /> cr�sc����r�n�3 — <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE Of WORK <br /> /� ��leclric Gas_Other � <br /> S� ` ��'S��r,v¢+' i1 — G+Soco . <br /> WORK DESCRIPTION <br /> ���� <br /> PLUMBING MEGHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITE�7 <br /> '� Toilet A/C—air handling units <br /> Balhtub Forced air systems <br /> � Lavalory(wash basin) _ Gas piping <br /> � Shower _ Waler heater <br /> _ Kilchen sink&dispusal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer C�olhes oryer <br /> Water healer Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> _ Backflow preventer Heat pump <br /> Urinal � Unil heater <br /> _� Drinking Founlain _ Boiler <br /> Floor drain _ Refrigeralion <br /> Grease lrap Woodstove <br /> Roof drains Other <br /> Olher _ — <br /> —I <br /> CITY OF EVERETT LOCAL SALES TN(CODE IS 3105 <br /> I hereby ceritify that 1 have read and examined Ihis application and know lhe same to be true and correcl All provisions of laws and <br /> ordinaces goveming this type o(w,�rk will be complied wilh whether speci(ied herein or noL �he granling o(a permit does not presume <br /> lo give aulhority to violale or cancel�he provision of any other slate or local law regulating consiruction or Ihe peAormance of <br /> conslruclion.That I am aulhorized by lhe owner o(this property to pertorm Ihe work for which application is made and I compiy with lhe <br /> Slalo Contra/ctQr�Lsw 18.27 RCW and 296.200 WAC. <br /> (/ .., � �. 1� �� �`���lG' <br /> Signature o( wnedConlreclodAuthori:ed Agent ' te '/ <br /> /� <br />