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P� �RMIT APPLICATIC' V <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857-www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM !O� a ��� <br /> SITE ADDRESS 'tj�C�'1�j )L L PARCEL TAX I.D.# PERMIT# <br /> lll�� r�a�lwa 6v�rch' wA4�Zo8 OO�f902013�ObOZ ' - � -�;� <br /> LEGAL LOT N0. � BLOCK TRACT OR SUBOIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE �.zS N60- <br /> r� bfA''1G1'Y) C�horf�en�a�t IZOO�/ZfhAVGNE51'lGtZz- allllVvfw.tGAGb4 'y`'�o <br /> TENAN7 NAME I CONTACT FOR PERMIT , PHONE ��G „ <br /> �^� Yt `)1'G��'1C�rtL L1�-•�- y �-O- � lC. <br /> SLNY15( '(/(q�'�2/ COA�'rc� dt''N�f" E-MAIL <br /> NTRACT R ADDRE IT /ZIP P N <br /> To h� l/l�tr���t�! <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��) O (1�1I�� _Electric _Gas_Other (�•l(?� ���,� <br /> YT <br /> WORKDESCRIPTION f�arT�ql fIo°r Y{nan'� �M(�tOVl.�[.tY �r'i /nvl�lvo�{ �C�"�d� �6" J-�d^-9 ru�7`iC... <br /> 0 � Pnr'Fi'�'ionS� flODK' l�fGtti.tc� r(lOca�i�q ••tic/e�hfNy!«'F✓tfs i"Oc�ian, rOP V5� tiCJ <br /> C�1u..c,( u'Fo cc✓Pa�c% NO S�r�ctvral wer- K rn �,a/ .i.D �tia�.�{ 7�o b ��/�iKs <br /> Gt f CGI- <br /> PLUMBING Srpr•-4 Fr _ MECHANICAL -c r/���'4Yj <br /> N0. TYPE OF FI%TURE OR ITEM ���rM' t N0. TYPE OF FIXTURE OR ITEM P<r••,.�r <br /> Toilel _ !VC–air handling unils <br /> Bathtub _ Forced air systems <br /> _ Lavatory(�vash basin) _ Gas piping <br /> Shower _ Water heater <br /> Ki�chen sink 8 disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> � Clothes washer _ Clothes dryer <br /> Waler heater _ Range hood <br /> Sink(service/bar/mop/etc.) _ Exhaust fan <br /> _ Back(low preventer _ Heal pump <br /> Urinai _ Unil healer <br /> _ Drinking Fountain _ Eoiler <br /> Floor drain _ Retrigeration <br /> Grease irap _ Woodstove <br /> Rooi drains _ Olher_ <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritily tliat 1 have read and examined ihis application and know the same to be true and correct. All provisions of laws and <br /> ordinaces goveming ihis type ot work�vill be complied with whelher specified herein or no1.The granting of a permil does not presume <br /> to give aulhority to violate or cancel Ihe provision of any other stalo or local iaw regulating construction or ihe performance of <br /> conslruclion.That I am aulhorized by the owner of Ihis property lo perform the�vork for which applicalion is made and I compty with the <br /> State Contractor�La�y 18.27 RCW and 296.200 WAC. <br /> L <br /> �jc��l, �A5<.��) �o%r�/o8 ;� <br /> Si �et'ure of OwnedConlraclor/Authonzed Agent D e <br />