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PE�MIT Ai�PLICA�'IC)�� <br /> CITY OF EVERETT PERMIT SEE2WIGES <br /> 3200 CEDAR STREET, EVERETT, WA 9f3101 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 ADtl TO 4 PM <br /> SITE ADDRESS 37�3 l...�9 m�0.rd aV� PARCEL TAX I.D.# PERf'�IT# <br /> Everet+ � WfE. 9$aol '�f�3 0 -7(03 -0/ � -0000 I ,S c,'�� 0�� <br /> LEGAL LOTNO. y BLOCK TRACT <br /> DESC. QI A I%L. 7CO3"(�'00 <br /> OWNER ADDRESS CITY/ZIP PHONE y�S 7iO3 — <br /> l�!Aky y. Roberts 3ZZ3 �bqrd Ave �uereit/9F�ap1 ��3�f <br /> TENANT NAME I CONTACT FOR PERMIT PHONE �ZS <br /> I�/or7e /�/ar ,7ii,,.,�� �'risfina l.ulCG IP.�hErts 303-$�35� <br /> CONTRACTOR ADDRE GTY/ZIP PHONE <br /> CONTR. LICENSE# ^ , ^ <br /> w/`� ` <br /> USE OF BUILDING f I HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��- Q�kn��� �Eleclric �Gas_Other 3n� <br /> WORK DESCRIPTION £xZerlDY S�r:-s �'. �and,n9 ,P.�,Plac�rnen� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEh7 NO. TYPE OF FIXTURE OR ITEM17 <br /> _ Toilel A/C-air handling unifs <br /> Balhlub Forced air systems <br /> _ Lavatory(wash basin) Gas piping <br /> Shower Water healer <br /> Kitchen sink&disposal Gas fireplace <br /> _ Dishwasher Gas range <br /> _ Cblhes washer Cbthes dryer <br /> _ Water heater Range hood <br /> Sink(service/badmop/etc.) Exhausl fan <br /> _ �ackflow preventer Heat pump <br /> Urinal Unil healer <br /> Drinkin� Fountain Boiler <br /> _ Fioordrain Re(rigeration <br /> Grease trap Woodslove <br /> Roof drains Olher <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> iI I hereby cerility that I have read and examined lhis applicalion and know ihe same lo be true and correcL All provisions of laws and <br /> ordinaces govcrning lhis type of work will be complied wilh whether specified herein or not.The granting oi a permil does not presume <br /> to give authurity to violale or cancel lhe provision of any other stale or local law regulating construction or lhe performance of <br /> consln:ction.That I am authorized by the owner of this property to perform the work(or which application is made and I comply with the <br /> Sta�c Contraciors Law 18 d 296.200 WAC. <br /> 7 'y' <br /> Sigr,ature of e on(ractor/Authorized Agent Dale 1 r� <br /> L----- ------- — <br />