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P�RMIT APPLICA�'10�� <br /> ClTY OF EVERE i 1' PERMIT SERVICES <br /> 3200 CEDAR STfiEET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 P�A - DEBIT& CREDIT CARDS ARE NOT ACCC•PTED <br /> SI�E ADDRESS PARCEL.TAX I.D.}F �R/ MO3 `�� <br /> o/a sE Fv6�7T /�fi�c� w zo� 5!S o0 o�G oo u, <br /> LEGAL LOTNO. BLOCK TRACT <br /> oesc. SeG �l.0 <br /> OWNER ADDRESS CITY2IP PHONE <br /> E,�,ta�? �� Yo K�,erz&Y lot� , �oro cuc-�eEr,*� w/ �rrw� <br /> TENANT NAME CONTACT FOR PERMIT PI10NE <br /> �,g,�,�,,� �[DA Ucc,ea �c�NivGcc 06si4'�t/) �zr. G 70•G 7o G <br /> CONTRACTOR l�OURESS CITY2IP PHQ4E <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � <br /> ��/�z _Electric _Gas_Other �S� (�'r��� <br /> WORK DESCRIPTION <br /> �jG-r�coG�77aw, tiEw p�4,2T/naNs, Cb�Mis/NG- IuAt[.� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling unils <br /> Bathtab Forced air systems <br /> Lavatory(wash basin) Gas pipin� <br /> Shower Water heater <br /> � Kitchen sink 8 disposal _ Gas fireplace <br /> ishd'wasl er Gas range <br /> Clothes washer Clothes dryer <br /> Laundry lray Range hood <br /> �ink(service/bar/mop/etc.j Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain � Boiler <br /> Floor drain Refrigeration <br /> Grease Irap Woodstove <br /> Roof drains Other <br /> Other <br /> i — — <br /> CITY OF EVERETT LOCAL SALES TAX C0�7E IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authonty to violale or cancel the provision of any other stale or local law regulating consWction or the performance of <br /> construction.That I am authorized by the owner of lhis property to perform the work for which application is maCe and I comply with the <br /> State ConV2ctors Law 18.27 RCW and 296.200 WAC. <br /> lP�wvr� i 3-a��o� <br /> Signature of Own r ontraclodAuthorized Agent Date <br /> /Z <br />