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_ —� <br /> PERMIT APPl.ICATIQN <br /> CITY OF EVERETT PERMiT SERVlCES <br /> 3200 CEDP.R STREET, EVERETT,WA 98201 <br /> 425-257-8810- FAX 425-25?-8857-www.evereriwa.org 7 �s"/� <br /> APPLICATIONS ARE ACCEpTED FROM 8 AM 1 O 4 PM �����-(,��> <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# ,� <br /> aa0 (o L w, l ��l � Lo ' O( J <br /> LEGA LOT NO. BLOCK iRACT OR SUBDMSION t <br /> DESC. <br /> OWNER ADDRESS CITYlLP PHONE <br /> �ti� po�►,c-w�vs ,� ob�x ► �ssr D�vtiI� L✓q 9�6�19 <br /> TENANTNAME CONTACTFORPERMIT PHOHE !-�'d�j 30�p ���3 <br /> I �oh w��I�y E�JIAIL <br /> � <br /> �+n2�62o <br /> hFAR 3RWS9aS1-R � 000 SW 3yrh St StaN 2��tD� wa �so;5� ��as) Gs6 �soo <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF W0�2K <br /> R LS �N L h � _Electric _Gas_Other � �� 7G+, � <br /> f� <br /> WORK DESCRIPTION <br /> �G�4�/ I 'IZ �iirn�SyG 10 7,�1�IL r'�r11,.1 ICt ,� /n L ftr �l'1'7xCN� �qN�_ <br /> PLUMBING 11aECHANICAL <br /> NO. TYPE OF Fl%iURE OR IiEM NO. TYPE OF FIXTURE OR�TEAA <br /> Toilet AIC—air handling units <br /> 1 Bathtub � Forced air systems <br /> � Lavatory(wash basin) _ Gas pipirg <br /> Shower _ Water heater <br /> �_ Kitchen sink&disposal _ Gas fireplace <br /> ,� Dishwasher Gas range <br /> 1 Clothes washer ,� Clothes dryer <br /> 1 Water heater l Range hood <br /> Sink(service/barlmopletc.) � Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal _ Unit heater <br /> _ Drinking Fountain _ Boiler <br /> Floor drain _ Refrigeration <br /> Grease trep _ W�dstove <br /> Roof drains _ Other <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> I hereby certify that I have read and examined this application and know the same to be true and correct All provisions of laws and <br /> ordinances governing this type of work wiil be compiied with wFiethx specified Fierein or not The granGng of a permit dces rwt presume <br /> to give authority to violale or pncel the provision ot any other state or local law regulating construCdon or the perf�xmance of <br /> construction.That I em authonzed by the owner of this property to perfortn the woric for which appiication is made an�i I compiy with ihe <br /> State Contradors Law CW and 296.200 WA�. <br /> //—I 0 ^ / <br /> � � : <br /> Signature of O n ntractor/Authonzed Agent � Date 1L �/ �; <br /> � <br />