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P�RMIT APPLICATII. N <br /> CITY OF EVERETT 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 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> ' 9/,3 F/�� .S/�� (�o yy95�U/o Soz� �S- l 8 <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> f',2/�rG, 5'//Jr�,z �/9r3 E/�r sT ,E����rr wr1- 9�av3 �s9 ��s� <br /> TENANT NA E CONTACT FOR PERMIT PHONE <br /> /yJ/�,7�G�'�� ����,C�K ° DGIJ/..�2� E•MAIL <br /> C��ALTbR —�DD�� I fY/�PFZSA� <br /> CONTR.LICENSE# %��� ��._^ i ,. <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Eleclric Gas �other :i ` :.�� 7J j <br /> WORK DESCRIPTION �/ � � i <br /> ��i�c,r7 t�'70 S� 1zka�%�r��Go� . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> �� BathWb � Forced air syslems <br /> � x Lavatory(viash bssin) _ Gas piping <br /> �_� Shower Waler healer r <br /> Kilchen sink&disposal Z Gas fireplace n/1��1.�- �y �� �� <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water healer Range hood <br /> Sink (service/barlmop/etc.) Z Exhaust fan <br /> ' Back(low preventer Heal pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Reirigeration <br /> Grease irap Woodstove <br /> Roof drains Olher <br /> Other <br /> I <br /> CITY OF EVERETT LOCAL SALES TAX GODE IS 7105 <br /> I hereby certify Ihat I have read and examined this application and know the same to be lrue and correct. All provisions of laws and <br /> ordinances governing this lype of work will be complied with whelher specified herein or not. The granting oi a permit does not presume <br /> to give authority to vio�ale or cancel lhe provision o(any other state or local law reguiating consWction or lhe pe�formance of <br /> conslruction. That I am aulhoriz�d by.ihe owner of ihis property lo pertorm the work for which appiication is made and I comply with the <br /> State Contra� L��jB'2].f�CWand 296.200 WAC. <br /> /, ,����-t�, �/-�3�'a0lD <br /> :, <br /> Signature of OwnedConlrac uthonzed Agent Date I' <br /> 2 <br />