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PERMIT APPLICATION G —a9 —o� <br /> CITY OF EVERETT PERMIT SERVICES ��i <br /> 3200 CEDAR STREET, EVERETi, V��A 98201 �'�c,� 7��-�z <br /> 425-257-8810 - FAX 425-257-8857 --www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM C� 7�3� <br /> SITE AD�RESS � /� PARCEL TAX I.D.# P RMIT# <br /> az L�� < .) ✓6 �' v�' � � 9 r G�l G "Lr�� ✓ <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE t�7f"-jj�-S1)7 <br /> I <br /> a�s� C���>Q�s ��� z� �f >�, s-rn,� �-�1,:.y.��u Ci�, �T— <br /> TENANT NAME CONTACT FOR PERMIT V PHONE <br /> �� TIc �- � l ��NeJ:r '-lL ��-zza -� `/) J <br /> CONTRACTOR,"�.�LO��J�/aC, ADDRESS CITYIZIP PHONE <br /> �1 S-f 7G ��y1 <br /> C�'ITR�ICE1JSe� %�74' D �-r i( �'H�ii�l�,��r .���r�. <br /> -� � � r �' C/� �,��� fv�:9yzyz <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � 1 ��� �/ G� ( r� �7 / �� T`�.' � XEleciric _Gas_Other yJ �', ��uE� <br /> WORK DESCRIPTION � <br /> �-j�lzeerr�/ ; <br /> L. Gr�, tri, r_ +;,,� ���� G. VleG� �c � h �'IG/ti� <br /> PLUMBING MECHANICAL I <br /> NO. TYPE OF FIXTURE OR ITEM11 NO. TYPE OF FIXTURE OR ITEM <br /> � Toilel � � A/C-air handlin�units <br /> Bafhlub 2_ Forced air systems <br /> � � Lavatory(wash basin)� '� Gas piping <br /> Shower / VJaler heater / <br /> ilchen sink 8 disposal ! � Gas fireplace <br /> Gas range <br /> � ishwasher ; Clolhes dryer� <br /> h_,Glothes washer I � Range hood � <br /> ' z, . Water healer �� Exhausl fan y- <br /> Sink(service/badmop/etc.) <br /> _;� Backflow preveNer ` Heat pump <br /> � Urinal �� � Unil healer <br /> Drinking Fountain � Boiler <br /> Floor drain _ Refrigeration <br /> Grease lrep _ Woodslove <br /> Roof drains _ Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 I <br /> ! hcreby ceritify that I have read and examired this application and know the same to be true and correcL All provisions of laws and <br /> ordinaces governing this type o(work will be complied wilh whether specified herein or noL The granling o(a permit does not presume <br /> to give aulhorily to violate or cancel the provision of any other stale or local law regulating consWction or lhe performance of <br /> conslruclion.That I am authorized by the owner of this properly to perform the work for which application is made and I comply with the <br /> Slate Conlraclors Law 18.7_7 RCW and 296200\NAC. <br /> i�� ,., ;;, �- , <br /> ,�-, . `�,� , -��l Z <br /> Sic�naWre of OwnedCort ractoNAuthonzed Agent Date <br /> ��L',cJ2��i'�" Yv <br />