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PERMIT APPLICATION <br /> CITY OF EV�RETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM l�l�J�J�J � <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# 9 <br /> 1 / —' l No�y� ���E O�rf666z.2i ao�ou ;��n,�� ",it'JG� <br /> LEfAL LOTNO. BLOCIC TRACT �1 ^ _ <br /> DESC. 5 Z2 / TlC7G�kS N-'�a• <br /> OWNER ADDRESS CITYIZIP PHONE y Z.� 7�UGS'7a <br /> M!-�rT�,.� �AMgea,— 1121 �-l07� A-.,� r'.�t<�i w� ��z�, <br /> TENANT NAME CONTACT FOR PER�d1T PHONE <br /> � Q G�SON �Z� 5U`d `I-75 Z <br /> CONTRACTOR �aCIFC GA 'I/��S INL ADDRESS CITY2IP PHONE <br /> Z�ZL� /��1Getr!' A�+e ��CV�rf <br /> CONTR.LICENSE# ��.� ��,� I Oi�U�N c1�Zu' <br /> gzs s�� 4�s'� <br /> USE OF BUILDING — �,SOURCE CONTRACT PRICE OF WORK <br /> �/-1/<'/�-(.'� E ect c�_Other ��1� O 00 .�'� <br /> WORK DESCRIPTION CGN i TM'r T �'t'J> Sa �--r /,�hc�2� ' 2`� ! <br /> 6,2.�acc t,�.,n� 6 uL� fazt,,�c-AEc�v <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FIXTURE OR ITEM NO. NPE OF FIXTURE OR ITEM <br /> Tcilet A/C–air handling units <br /> = Bathlub Forced air systems I <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> _ Kitchen sink 8 disposal _ Gas(irepiace �� . <br /> Dishwasher Gas range <br /> _ Clolhes washer Clolhes dryer <br /> Water healer Range hood <br /> Sink(service/bad �/elc.) � � Exhaust fan <br /> BackOow prevenler Heal pump <br /> Urinal Unil healer <br /> Drinking Fountzin Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify Ihat I have read and examined lhis application and know the same to be true and correcl All provisions of laws and <br /> ordinaces governing lhis type of work will be complied with whelher specified herein or noL The grenling of a permit does not presume <br /> lo�ive authority to violate or cancel the provision o(any other stale or local law regulaling construction or the performance of <br /> conslruction.That I am authorized by the owner of this property to perform the work for which applicaiion is made and I compty with lhe <br /> State ConJac�o� 18�7 RCW and 296.2D0 WAC. <br /> �i /� <br /> l'�G� ( �/'� 7��0%� <br /> Signature of OwnedContractor/Aulhorized Agent Dale � <br /> - ;7:� �Z <br />