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, PE�aZMIT APPLICA''la. ; -. _,_`-, __` / i <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 /> APPLIC.4TIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT i:ARDS ARE NOT A!::.EPTED <br /> SITE ADDRESS PARCEL TAX I.D.SF PFRNI7lf <br /> �p21 S�E e1Jf. ,GIIPi-� CJ/�- � 18 OSlB oe3 Do9 C10 l��� So(r � v�/, <br /> � LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> UWNER AD�RESS :ITY/ZIP PHONE <br /> La� u��-rvi3 9�$Sb <br /> �n/.z / t�+^ �S ��r �� S V�1� 73 / 2 � LaKLS�.arP �✓� G�kc ST<�e�s I✓.� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �eX�+y SlJ�r.(�Or. 29�—Y`( 9-� 39 � <br /> CONTRACTOR ADDRESS CITY.�ZIP PHONE I <br /> .�J_ �i�.i��S G.�..�. ST�rr C�.,J' 13�� �� .z�27>`S?_ S� .swd�o.�.7� Wv �=d-944-e396 � <br /> CONTR.LICENSE# <br /> o�.,,,yS G��s.v y <br /> USE OF BUILDING HEAT SOURCE CONTf�AGT PRICE OF WORK <br /> -S- �S �c T<H.-1/ -S" do' :crt �. <br /> �Electric Gas Other 'r" 6 y"�< o <br /> .�.aSP6�.oy?i e/ '�' _ /OSJDOD. <br /> WORK DESCRIPTION <br /> ;��/c� /,��.�/-1 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR IT[M <br /> Z Toilet A/C-air handling unils <br /> � BathWb Forced air systems <br /> 2 Lavalory(wash basin) .j� t/ Gas piping — r" - �'�"6c� F��f a � g <br /> % Shower i� Waterheater £/r <br /> � Kitchen sink&disposal / ` Gas fireplace <br /> / Dishwashcr i ✓ Gas range <br /> / Clothes washer / ✓ Clothes dryer <br /> Laundry tray ! � Range hood <br /> Sink(service/badmop/etc.) �Y Exhaust fan <br /> / BackOow preveNer Heat pump � <br /> _ Urinal �'/ Unithealer o �+"�- �-`1 aas� 6v`ti`� <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeralion <br /> Grease trap Woodstove <br /> � Roof drains _ Olher <br /> Olher � <br /> — -- I <br /> CITY OF EVERETf LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritiy that I have read and examined this application and know the same to be true and correcL All provisions of laws and <br /> ordinaces governing ihis type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> ro give authonty to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> .nstruction.That I am authorized by the owner of this property to perform the work for which applicalion is made and I comply wilh lhe I - <br /> tate Contractors Law �8.27 RCW and 296200 WAC. <br /> �-��~ � � �,�-�-- l v -�,/ 6��f D S <br /> .q�nature of Owncd lr�SctodAuthonzed Agent Date - � <br /> ( ����, � <br />