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F'ERMIT APPLICAT�ON <br /> CCTY OF EV�REYT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM Q � �I �O� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> �'"� l� i�sii�a�% �v�r�•T «'- UOSSG?�/oo�00 3na � �50 • -U ly <br /> LE3AL LO7'N0. BLOCK TRACT OR SUBDIVISION# / <br /> DESC. �..Z ��7 ,l0% OF :Sl,c,�i✓�/uT S� l %- 77 <br /> OWNER ADDRE55 CITYIZIP PHONE <br /> �/�t�l.,�t `iP1 L' � �tRn�i7 S �O//O /�/1�laT/-J .t�74-L-r <br /> TENANT NAh1E CONTACT FOR PERMIT PHONE�/Z S '�Z.3-U.34G <br /> S/4'VVl<— / 'e/U�A. / �DYYlI� � E•MAILKe'//J�G�n�n.�.5 /L �/4[��� <br /> CONTRA— � p�— ADDRESS CITYIZIP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �[Src<<'.i1C � �Eleclric v�Gas_Olher <br /> WORK DESCRIPTION ����7���,� '�e�;.;�.�% , ' <br /> f' yG� �� S�/v.�'j /3 X �/S ' <br /> /-lI7Ck�,� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTIIRE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilet _ A/C-air handling units <br /> /_" Bathtub Forced air syslems <br /> �_ Lavalory(wash basin) ?y_' Gas piping <br /> / Shower _ Waler healer <br /> � Kitchen sink 8 disposal Z�� Gas fireplace <br /> / Dishwasher _ Gas range <br /> �� Clolhes�vasher _ C�olhes dryer <br /> / : " Water healer )�L Range hood <br /> - Sink(service/bar/mop/etc.) I Exhausl fan <br /> Back(low prevenler _ Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain _ Boiler <br /> Floor drain Re(rigeretion <br /> Grease Irap _ Woodstove <br /> Roof drains Olher <br /> Other <br /> � <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> I hereby ceritify that I have read and examined lhis applicalion and know the same lo be true and correct. Ail provisions o(laws and <br /> ordinaces goveming this type of work will be ccmplied wilh whether specified herein or nol.The granling of a permit does not presume <br /> lo c�ive authorily loyiWate or cancel lhe provision of any olher stale or local law regulating construclion or the peAormance of <br /> construclion.Thal I am aulhorimd by the owner of Ihis property to perform lhe work for�vhich applicalion is made and I comply with lhe <br /> Sl�COntr�ctors Law 18.27 RC and 296.200 WAC. <br /> ����� G�a�,�� 7 d��d� <br /> Signa}ure of OwnedContraclor/Aulhorized Agent — Dale I <br /> �z <br />