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P�rtMIT APPLICATId�J <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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARD� ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> =�OS oo- - ca� -039 - o0 <br /> LEGA LOTN . BLOCK TRACT <br /> DESC. 39 �QO ^0� /3�v�rl � //S � . � <br /> OWNER P�, ADDRE55 CITY2IP PNONE <br /> �Il���rsoh yo5 l�/a ho�a �v�re�98Zo3 �23z /Y�9 <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> � l��f/ 7ed�v (y�,�3-8iov <br /> , <br /> CONTRACTOR 7'`)f Tf,�,�w�� �`OF AOORESS o CITY2IP PHON� <br /> f�v. 8ox 30/S� � Ev. ref/� 98203 ry�3o3-8/Gi� <br /> CONTR.LICENSE# <br /> -TREv w� i 76�o <br /> USE OF BUILDING I — HEAT SOURCE J,CONTRACT PRICE OF WORK <br /> Electric Gas_Olher fJ��S�O. Q Q <br /> WORK DESCRIPTION <br /> D��,�D/�Sh haus�� �%ar �P6ris �ru��� /a�� hGc�,/ aw�y <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet AIC—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposai Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unii heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeretion <br /> ^ Grease trap Woodstove <br /> Roof drains Other <br /> ^ Other_. <br /> CITY 0�EVERETT LOCAL SALES SAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the sam2 to be lrue and correct. A!I provisions of laws and <br /> ordinaces governing this type of work will be complied wilh whether specified herein or not.The granting or a permit does not presume <br /> to give authority to violale or cancel lhe provision or any other state or local law regulating consWcUon or the performance of <br /> cons ' n.That I am autho�ed by th owner of this property to perform the work for which app�ication is made and I comply with the <br /> /State Contr tors Law 18.27 RC�D/and 2 6.200 WAC. <br /> � ,. <br /> � // / �� <br /> Sig ature of Owned ntracroNAuthorized gent ate <br />