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PE�2MIT APPLICATION <br /> CITY OF EVERETT PERMIT SEF�VICES <br /> 3200 CEDAR S7REET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettw�.org <br /> AF'PLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ��—0 S�� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> �''ZO �C�1�enC�. O04 3 7-�r'�Z.f�7Z G� -a�� <br /> LEGAL� LOTNO. BLOCK TRACT ,7 � <br /> DESC.'S� ! Z �Y Z�S L.�ZI I � �✓�`*"�r.T- �IV ({ <br /> OWNER ADDRESS CITYIZIP PHONE <br /> ���INOR l�c��i�( 20?�D i,c�NlK�2� s-r �V��rr 9�20/ <br /> TENAN7NAME CONTACT/F'ORPERMIT 117 �SrI� � PHONE <br /> J6W J�A/J,IJ��/"l GUrU_^^a6 �{Z5• 359• 91�-� <br /> Ct}4 <br /> COWTRACTOR AUDRESS CITY P PHONE <br /> �oSS�SS�onl Sow.�D ('oat�'zAra��2s �/zs_ 3,�q. �sa� <br /> CONTR.LICENSE# �SS `�c�S3 f� < 2�l 7 �S � � E fE�7� !��' Qh'2p/ <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ,{�A�t�'�I SK �7��� _Electric _Gas_Other <br /> WORK DFSCRIPTION <br /> ?��i�',�� � S�l �/�1G� ��/'/-�'�`� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling unils <br /> Bathtub Forced air sys�ems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Waler heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Waler heater Range hood <br /> '� Sink (service/badmop/elc.) _ Exhausl(an <br /> + Back(low prevenler _ Heal pump <br /> Urinal Unit healer <br /> Drinking Founlain _ BoilEr <br /> � _ Floor drain _ Refrigeralion <br /> Grease lrap _ Woodslove <br /> Roof drains Olher _ <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TA7C CODE IS 3105 <br /> I hereby cerilify lhat I have read and examined lhis application and know lhe same to be lrue and correcl All provisions of Is.vs and <br /> ordinaces yoveminc� this type of work will be complied with whether specified herein or noL The granling o(a permit does nol presume <br /> to give authority lo violale or cancel the provision of any olher stale or local law regulating conslruction or lhe performance of <br /> conslruction.Thal I a uth . y the owner o(this propeA�•to perform the work for which application is made and I comply with the <br /> Stato Conlr ctors L 18. and 29G.200 WAC. <br /> � � �� '� �� <br /> �gna re o, nedContrec or Aulhorized Agent Dale <br /> �/2 <br />