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- ------� ------- -- —�--- -- <br /> '� PERMIT APPLICATION <br /> I CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 987�1 <br /> 425-257-8810 — FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 A«i -I O 4 PM <br /> ISITE ADDRESS �H6CLSF PARCEL TAX I.D. # PERM�T# � � ,) <br /> � <br /> 23 3 ��/e 2.� �Ve - G�,�,� ��� � U � � ' � <br /> ' LEGAL LOT NO. BLOCK TRACT OR SUBOIVISION# <br /> DESC. � <br /> iOWNER ADDRESS CITYIZIP PHONE � <br /> , � 1!A ►ZZc y A-Y.l� S 23f 3 �l/erLa.l� ��/C-- ��e�ctl � 9�'Za� �a'��9�17-3e�3 j <br /> '� TENANT NAME CONTACT FOR PERG1IT PHONE �'J�C./�S '7�f��- <br /> . �ORa �/ /Y!-1 XAN L�C-2 E�MAIL <br /> '�,I CUNTRACTOR �NUUC�nITRJ�C�ORS ADDRESS CITYIZtp PHONE <br /> i CONTR. LICENSE tl � <br /> ! Ps�c�►¢�o�r��� Po �,x z.s-�y �C=�.�cc,a���� ZS3- YQs- 78Ys" : <br /> � USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK I <br /> — _ Eleclric _Gas_Other I <br /> WORK DESCRIPTION / � <br /> ��-�4 rYov+l D�' �+f+.$ T�1 E"�C��S ` � �T""� ` � -.3 <br /> 3 'tS <br /> � �� � rn a ti�z�� i-e. ���� <br /> PLUIViBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITE67 NO. TYPE OF FIXTUftE OR ITEM <br /> Toilet A/C -air handling ur,iis <br /> _ Dathlub _ Forced air systems � <br /> _ Lavatory (wash basin) Gas piping I <br /> Sho�ver Waler heater , <br /> Kitchen sink&Aisposal _ Gas fireplace � <br /> Dishwasher _ Gasrange i <br /> Clolhes washer _ Ctothes dryer <br /> Waler I�eater Range hood � <br /> Sink (service/badmop/etc.) _ Gxhaust fan <br /> BackOo«�prevenler _ Hcal pump <br /> Uiinal __ Und heater <br /> Dnnking Fountain �otler <br /> Floor di,m Reingeration <br /> Grease trap _ Woodstove <br /> Roof drams Olher <br /> = Olher = i <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certity Ihat I have read and examined this applicalion and know Ihe same to be Irue and correcl. All provisions of laws and <br /> ordmances governmg this type of work will be complied�vith whether specifed herein or not. T he granting ot a permil does nol presume <br /> lo give authority lo violate or cancel Ihe provision of any other state or local law regulafing conslruction or ihe pertormance of <br /> construction. That I am author¢ed by Uie owner of Ihis property to perform the work(or which applica6on is made and 1 comply wdh Ihe <br /> S�a�e Co r�c�ors Law 8 RCW and 296200 WAC. <br /> � �/-�-/O <br /> Signature ol wnedCon racrodAuthorized Agent Date <br /> I <br />