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P��RMIT APPLICATIQN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 99201 <br /> 425-257-8810- FAX 425-257-8857-wv✓v�.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TG 4 PM <br /> SITE ADDRESS AP. gL TAX I.D.# PERMIT# <br /> Z5�6`/ ZS-/v G G/ VG • GoSe�!`%tv/3oodo/ � � �� -Od <br /> LEGAL LOT NO. BL9OCK TRACT OR SU DIVISION k <br /> DESC. �-S I7 I��G <br /> OWNER ADDRCSS CIN/ZIP PHONE <br /> fii,�„� �a�.r.iy�, �-�if�i�iL� P. c� Gex /Sy�- �'✓r�r�f 9fZaG yZt u"d- 92Z2 - <br /> TENANTNAME � ��— � CONTACTFORPERMIT PHONE Y1$'-�03 ' //L� <br /> /��it plllilte�� /��LGie, E•MAII�J'r�rii/Rm�tv/t� <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE <br /> CONTR.LICENSE# /(� <br /> �}.y`pJ�,�cG� l..N�l,�J���-G�°J <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> L � � <br /> GRrp.�� E D�'vG�"Rvf _Elechic _Gas_Other ���CGI�. � _ <br /> WORK DESCRIPTION �' �� �1�-� <br /> ' �eiv G�ri✓ck,a� �t,n.�l C<.✓'�Jirf /�jX �� <br /> PLUMBING , MECHAN�CAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE Of FIXTURE OR ITEM <br /> i oilel A/C-air handling units I <br /> Balhtub Forced air systems I <br /> Lavztory(wash basin) _ Gas piping <br /> Shower Water heater . <br /> Kitchen sinh 8 disposal _ Gas(ireplace <br /> Dishwasher Gas range <br /> Clothes washer _ Clolhes dryer <br /> Water heater Range hood <br /> Sink(servicelbadmop/etc.) Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal Unil healer <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceritify lhat I have read and examined this application and know the same to be lrue and correcL All provisions of laws and <br /> ordinaces governing this type of work will be complied with whelher specified herein or not.The granting of a permit does not przsume <br /> to give aulhority to violate or cancel the provision of any other stale or local la�v regulating construclion or the pedormance of <br /> conslruction.That I am aulhorized by ihe owner of this property to perform the work for which application is made and I comply with lhe I <br /> State Contr�tors Law 18.27 RCW and 296200 WAC. <br /> . <br /> �� �c" ; ?2���� <br /> �a� �' - <br /> � _.� � <br /> Signa}uYe of OwnedContraclor/Authorized Agent ' Date' ( <br /> �L__. <br /> / <br /> � � <br /> /G'�' <br /> i. <br /> .fy. :: <br /> �y <br /> Wr•�' � " <br /> � <br /> ..... ., .�[-:.s. ... .. _ .,._ . • ..::. ��. q ., .� ..a �.. . ,�?.:c. ._ ... .. :.-c�..� r� �.- <br /> Ja �_.�' 'L�1]�_ a.... : ... . . .. .a.. .. ` ... . , . ....�,•' <br /> :�.. <br />