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P�RM(T APPLICATION <br /> CITY OF EVERETT PERMIT 3ERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8310- FAX 425-257-8857 -www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � -G��U O <br /> SITE ADDRESS PARCEL TAX I.D.# PERl�IT# <br /> �, <br /> ���_� /� ' <br /> �%E :c� ^' M<iL� WA �Jt ct� 7/. , I '-r'i -'- _�Ct�dG� +1/. L � �'�,�� <br /> LEGAI LOT N0. ' BLOCK TRACT OR SUBDIVISION it <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE 42� 4.3r�_'�j3�Z <br /> ��(r���-� Ma« or-r-�� r�wc. �.�� lcto �ti-�,��rr Nau. ��r �� ��2 Y��Frr u�W. �ia �P� <br /> TENANT NAME CONTACi FOR PERMIT PHONE (�.�QS) ��_C�Q��� <br /> � <br /> �UG� �F��o fk?y� �(.+tiirt�1��E - (�MarcL. cC�1-((�A e•Ma����rvwc��.ctit.o�.L.4�NhuK�l.c.a� <br /> CONTRACTOR A�DRESS CITY/ZIP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> f � <br /> ������� C.F��� _Eleclric _Gas_Other ���j�GJQ �° <br /> WORK DESCRIPTION <br /> ��i�o ��v�?��n�� � .7,�� 2� ,vIAKE 7'=r,cti< �o� 2 ,�'l�w �ll,uir� c���c�s. � <br /> � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIaTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air h2ndling unils <br /> Balhlub Forced air syslems <br /> Lavalory (wash basin) Gas piping <br /> Shower Water healer <br /> Kilchen sink&disposal Gas(ireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> _ Sink(service/bar/mop/elcJ Exhausl fan <br /> Back(low preventer . �{��) Heat pump <br /> _ Urinal 1 � ;,U- Unil heater <br /> __ Drinkinc� Fountain ��,;/. � /��`�1�U — 6oiler <br /> _ Floor drain � ' 1 v Re(rigeration <br /> Grease trep � �\ � Woodstove <br /> _ Roof drains '�, � � Other <br /> _ Other � ���' _ _ <br /> — ,�� — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y Ihat I have read and examined this application and know ihe same lo be true and currecf. All provisions of laws and <br /> ordinaces governing lhis type of work will be complied wiih whether specified herein or not.The granting of a permil does not presume <br /> to c�ive authority to viclate or cancel the provision of any other state or local law regulating construction or the performance of <br /> conslruction. Thaf I am aulhorized by the owner of lhis property to per(orm the v+ork for which application is made and I comply wilh the <br /> Slale Contractors Law 1fjf17 RCW and 296.200 WAC. <br /> / <br /> �//„%�"� � - / -o�� <br /> Signalu� e onlraclodAuthorized Agenl Dale <br /> \I� <br /> -- — -- - � <br />