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PtRMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, Wr;98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRES/S ^ PARCEL TAX I.D.# P�RM��//, / 7 <br /> �i/� L�t1�l1L4,��,/✓LL' W'�f'S—LR�� C '.G�/CL'� �'--' / /rY <br /> LEGA LOT NO. BLOCK TRACT OR SJBDIVISION# <br /> DESC. <br /> OWNER A��RESS CITY2IP PHONE <br /> Lis�° l�i�a<���i,�'I1 /,�il/ Gom����i�E� E���-� �fZS-ZSZ-YCJ�L <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> E-MAIL <br /> O TR CT R A00 �TT�/7.1� P O <br /> �1F�r/r,��°��c�,�aE'.� /zyz3/�. ��,yi<IG'NGi9�— tF�f,fra�1 'ZDE ��+�S <br /> CONTR.LICENSE# GrFEJ�T�C���/ F'�' �l/�/�!� �,l I <br /> USE OF BUILDING / HEAT SOURCE CONTRACT PRICE OF WORK <br /> �t},—��C/S�h;yt' G{E�]��'/(F!� _Eleclric _Gas_Olher �� ,� <br /> b <br /> WORK DESCRIPTION <br /> G«,/� ��l��:/���u���„�,s/��y�J�� � � = � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> _ Toilel NC—air handling units <br /> Balhtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Wa�er heater <br /> Kitchen sink 8 disposal Gas fire�lace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water healer Range hood <br /> Sink(service/badmop/etcJ Exhausl fan <br /> Backflow preventer Heat pump <br /> Urinal Unit healer <br /> Drinking Foun�ain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Rouf drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> I hereby ceritity lhat I have read an�examined this application and know ihe same to be Uue and correcL All provisions of laws antl <br /> ordinaces oveming ihis type o(w will be c plied wilh whelher epecilied herein or noL The granting of a permit does not presume <br /> ro give a hotiry to violate9�cancel :4�'pro ' ion any other state or local law regulating consiruction or ihe pertormance of <br /> constry tion: That I am uihorize y th ne f this property to perform the work for which application is made and I comply with the <br /> State�on)ractors Law" 27 an 6. WAC. , <br /> � � � /3 G'7 <br /> Sig ure of ner/C ractor/ uthorized Agent Date I � <br /> 1�J <br />