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� <br /> P�RMIT APPLICATIO�rI <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-ww�v.�verettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 7 -/D-O� <br /> SITE ADDRESS �y��,/�� PARCEL TAX I.D.# PERMIT# <br /> Q� -'//l�^c%LL iYv `- I�C1�U�7�Ol <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDFESS CITY,�2 PHONE <br /> f i2� ��a � SOz3 Cla.)-.,,�.�Y� GU�y �T'`�q�� �zs-2o�Y- �!5'0� <br /> TENANT NAME CONTACT POR PERMIT PHONE <br /> [7C:1�? � �C:C( CVa /S/aL/ E AZ�' Z.38—17L � <br /> NTR C R ADDR � <br /> G�y/G���-- J�a�<S ►�,�'<.u.h-c. 36O/ ��ri��`� yzj' Z5�'Z./6/ <br /> CONTR.UCENSE M ,Lv� t�� �Pw/ <br /> L� (/ <br /> USE OF BUILDING I HEAT SOURCE CONT^4CT PRICE OF WORK <br /> /+ ry <br /> G�n�M L'��G'�/ _Eleclric k Gas_Other �� � 7 � �� <br /> WORKDESCRIPTION �e ���r •�L- �.�i s `7e2 J` aClCi � G <br /> / ' <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling units <br /> Balhtub Z Forced air syslems <br /> _ Lavalory(wash basin) Z.� Gas piping <br /> Shower _ Waler heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gasrange <br /> Clothes washer _ Clothes dryer <br /> Waler healer Range hood <br /> Sink(service/bar/mop/elc.) _ Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal _ Unit heater <br /> Drinkinc� Fountain Boiler <br /> Floor drain Re(rigeralion <br /> Grease Irap _ Woodslove <br /> Roo(drains _ Olher <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> I hereby cerilify Ihat 1 have read and examined lhis application and know the same to be true and correct. All provisions o(laws and <br /> ordinaces governinc�lhis type of work will be complied with whetlier specified herein or nol.The granting of a permil does nol presume <br /> to givo authoriry tc vioiate or cancel lhe provision of any olher stato or local law regulating wnstruclion or lhe pertormance of <br /> conslruclion.Thal I am authorized by the owner o(lhis property lo peAorm the work for which application is made and I wmply with lhe <br /> State Contractors L j��W and 296.200 WAC. <br /> � 7_��g <br /> Signalure o wner C ntra odAulhorized Agenl Dale <br />