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PtRMIT APPLICATION � <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAF, STREET, EVERETT, �NA �8201 <br /> 425-257-8fi10 — FAX 425-257-8857—www.everettwa.org <br /> APPLICATIQNS ARE ACCEPTED FROM 8 AM TO 4 P�^. <br /> S�?E ADDRESS PARCEL TAX I.D.# PERMIT# <br /> l�o/l ��0� /'lr�P ULy01 —G�L� <br /> LEGAL LOTN . BLOCK TRACT ' <br /> DESC. <br /> OWNER ADDRESS CITY2IP 'YONE <br /> i �, , —6,3 <br /> ._�'"" �c..rC�'✓ � l(:ll l-�j7 �i!/r. �`:lf�c� ,"6oul <�,��� �r�J <� � <br /> TENANT I�AME CONTACT FOH PERh'�IT PF10NE <br /> I _ San'+r .�i ��t.�n.T <br /> -•. `iRAGTOR �, � CIlY21P PHONE <br /> ...q..41u> >�r���rs ct AODRESS <br /> � sad. cc• ;�P_=� yt{�'' ft'rr 6v. ��,nk`��r� `,;}S= �l`:�U—IzSu <br /> � CONTR.LICENSE <br /> 5�/.�rvss.�y3a _ �a�; � ' <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � // <br /> _-in�,��- �c-n���y K�> �Eleclric _Gas_Other <br /> WORKDESCRIPTION ��m.d,/f .`Ir.� it/c.'�.- (��r,:��,•� d QCP��.��. ,�.f�-, n '�v <br /> PLUMBING MECHANICAL <br /> NO. TYPF OF FIXTURE pR ITEM NO. TYPE OF FII,TURE OR ITEM <br /> _ Toilcl A/C—air handling unils <br /> _ BalhluL Forced air systems <br /> __ Lav2tory(wash basin) Gas piping <br /> _ Shower � Waler hea�er <br /> Kilchen sink 8 disposal Gas fireplace <br /> _ Dishwasher Gasranue <br /> _ Clolhes washer Clothes dryer <br /> _ Walerheater kangehood <br /> _ Sink(service/baqmop/elc.) Exhausl fan � <br /> _ Backllow preventer Heal pump <br /> _ Urinal Unl heater <br /> _ Drinking Foun�ain Boiler <br /> _ Floordrain Refrigeration <br /> _ Grease trap VJoo�stove <br /> _ Roo(drains Other <br /> Olher — <br /> i _ I _ — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> I hereby ceritify Ihat I have read and examined Ihis application and know thr, same to be true and correr.L All provisions of laws and <br /> ordinaces goveming this lype of work will be complied with whether specified herein or not The granting of a permit does not presume � <br /> lo give authority to violate or cancel the provision of any other state or Iccal law regulaling construclion or the pedormance ot <br /> construction.That I am aulhorized by the owner of ihis property to perform the work tor wh�ch applicalion is mad2 and I comply with the <br /> State Contractors Law 18.27 R W and 296.200 WAC. <br /> �i����.� �7/�t y�'Y" <br /> S� r�a c�of wner Contractor Authonzed Agent '—�a�y— <br /> 1� <br />