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P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � _aq--D <br /> 425-257-8810— F/aX 425-257-8857—www.everettwa.org � <br /> APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM fn D7�3- �Q <br /> SITE ADDRESS � PARCEL T,'�X I.D.# P RMIT# <br /> a� c�� , �� UO G(� �u ' 6 y 0 ZI a�� <br /> LEGAL LOT N0. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP � PHONE yzsrz�-sy�3 <br /> dF.�4s� �ri3�DR�ss �6?Xr Z�y i'� S7'R� /����+a�s.., �/�P'� 7_Z <br /> 7ENANT NAME <br /> � CONTACT FOR PERMIT � PHONE � <br /> �K' l�IZ C� ( I�AVLJ't ytJ`-22ri -.r9�3 <br /> CONTRACiOR,'�1['Q{-��hC, ADDRESS CITY2IP PHONEu�S_�7G'��,� <br /> I <br /> NTR.LICEIJ E# � <br /> ��iLG�y�97-7�D �UC VrfNiof�,�lrH��r�. Cf� h,¢yr� �ji�t�4,9yZ�Z <br /> USE OF BUILDING HEAT SOURCE CON7RACT PRICE OF VVORK <br /> V�J ����I i �. ( r '� �� 1�� 7`"' � -XEleclric _Gas_Other y�G. oti �j <br /> WORK DESCRIPTION � / <br /> �(la�-_ <br /> L. G h, fv4 c f�.�� u� G. NeU.• �o '+� h �'IG/�+e " <br /> PLUMBING MECHANICAL <br /> ' NO. I TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel i A/C-air handlinc� unils <br /> Bathtub 1 Forced air systems <br /> � Lavatory(wash basin) � Gas piping <br /> �(L Shower 1 lVale•heater � <br /> � itchen sink 8 disposal / � Gas f replace <br /> ishwasher � � Gas range <br /> � lolhes washer I Clothes dryer / <br /> �V Waler heater � Range hood � <br /> Sink(service/bar/mop/elc.) Exhausl fan� <br /> "i Backflow prevenler �"� Heal pump <br /> � Urinal � Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeralion <br /> Grease trap , _ Woodslove <br /> Roof drains _ Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby cerilify that I have read and examined this application and know the same to be true and wrrecC All provisions of laws and <br /> ordinaces goveming lhis type of work will bo complied wilh whelher speci(ied herein or not.The granting of a permit doos not presume <br /> to give aulhority to violate or cancel the provision of any other slate or local law regulating conslruction or the performance of <br /> consVuction.That I am authorized by the owner of lhis property to perform the work for which applicalion is made and I comply wilh the <br /> Slale Contraclors Law 18.27 RCW and 296.200 WNC. <br /> i3-�.� '��2'� j��. Z <br /> Signature of Owner/Co ractor/Authonzed Agent Date <br /> y <br />