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pERMIT APPLICATiON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org �` 6 �� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.;' PERMIT# <br /> � <br /> �� �- � _ �� o � y���ai� .n G�'c�7- i� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CIT/IZIP PHONE <br /> �,�� /���G��,��v y�il��/«�F� ��-�;ot� <br /> TENANT NAME �TACT FOR PERMIT PH l� 2 3�9' 7��i z <br /> .,,( r� <br /> �/ �N �G(/!r//��(/7 E•MAIL <br /> C NTRACTOR ADDRESS ITYIZIP <br /> /j�i,r���/� �<� C�Nff,��.r�� fc� �_� c:f-i��� f�- E��,Fr� yzr- �1�t'����3 <br /> CONTR.LICENSE p <br /> !f ii nn r'✓if'( 9S %/I/C <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> S��� _Eledric �Gas_Other �,���4�� <br /> �' <br /> WORK OESCRIPTION , <br /> / /��4 <br /> � 'f� ��G'Gl' cl�t �//�r6� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM I <br /> 2 Tollet � A/C—air handling units <br /> Z Dathtub � Forced air syslems <br /> 3 Lavalory(wash basin) _L Gas piping <br /> � Shower � \Naler heater <br /> Kitchen sink& disposal � Gas fireplace <br /> Dishwasher Gas range <br /> _� Clothes washer L Clolhes dryer <br /> C' Waler healer Range hood <br /> Sink(service/bar/moplelc.) _ Exhausl fan <br /> BackOow preventer _ Heat pump <br /> Urinal Unil healer <br /> Drinking Fountain _ Boiler <br /> Floor drein Refrigeretion <br /> Grease lrap _ Woodslove <br /> Roof drains Other <br /> Other _ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this applicalion and know the same to be We and correct. All provisions of laws and <br /> ordinaces goveming lhis type o(work will be complied wilh whether specified herein or nol.The granling of a permit does nol presume <br /> to give authorily lo violate or cancel C-,e provision of any other slale or lecal law regulating consWclion or the peAormance of <br /> conslruclion.Tha am authorized by the owner of this property to perform the work for which applicalion is made and I comply with the <br /> State Contr ory w 18.'27 R J and 29 O.W — , <br /> ( i; / ` �� 1� L-/!�/ /7l�f�c�..-� Z� / �/�� I <br /> Signat re of OwnedContractodAuthorized Agent Date ' <br /> �V <br /> / <br /> L <br />