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PEKMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICE� <br /> 3?00 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 �� _ (g-06 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 2.� 20 �-. �� y37� � d21- ozZ-oo , 1; � � - i � <br /> LEGAL LOTNO. BLOCK TRACT � � <br /> DESC. 2,Z ' L� 2q NW 20 2q �5��(,/�ti" e,� w1F.�,n'- D�J• K <br /> OWNER , I ADDRESS CITY2IP PHONE � <br /> � A L�N � ;g- /`�� �()� 20?.b �P'I ��R.� ST ,,� �E�7I 4'�32s>/ <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> CONTRACTOR � CSGSSIpN S(^,(�1� � •OADDR_ �ESMS�ti ZII Ir ISI�I PST �P✓��� ��� <br /> J t /�I KJI i^v <br /> CONTR.LICENSE#�O CC ` �Cn�� Q r� yZS� 3s9 � 9 s`�7 <br /> JJrt —1 I7� <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �/�'J�� _Eleclric _Gas u Other 32� lYJO. ^� _ <br /> i � �.� � •1 <br /> WORKDESCRIPTION ��5��� �r, , �iLrj� �f �/N/�`� (Y.�,Q��F�M6L,/-rN <br /> GW /7!�'r'1'y C^ / <br /> oc,r� �►9-�4� 3 cfie Po�; A�0 G(��rr,✓� _ � <br /> ' d� x � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet N'C—air handling unils <br /> BathWb Fnrced air systems <br /> avatory(wash basin) _ Gas piping <br /> Sh er �� _ ler healer <br /> Kitche sink& disposal Ga replace <br /> Dishwas Gas re e <br /> Clothes was r Clothes d r <br /> Watr.r healer Range hood <br /> Sink(service/badm e . _ cxhaust fan <br /> = Backflow preventer Heat pump \ <br /> _ Urinal \ Unit hea \ <br /> Diinking Founl ' � Boiier v <br /> Floor drain \ Re geration <br /> Grease lr Woodstove <br /> Foo(d ins ' Othar <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify Ihat I have reaA and examined this applicalion and know the same to be true and correcL All provisions o(laws and <br /> ordinaces governing lhis type o(work wiU be complied wilh whether specified herein or noL The granting of a permit dues nut presume <br /> lo give aulhority to violat or cancel the provision of any other state or Iocal law regulaling conslruction or lhe peAormance of <br /> I consUuclion.That I am ulhorized by the owner of this properly to perform the work for which application is made and I compty with the <br /> Slale Co lraclors La tf�.27 RC a 296.200 WAC. <br /> 9 Z� - o� <br /> Signa re of Ow dContracloriAulhorized Agent Date <br /> ��1 <br />