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Nay. 2i. 2U12 i2: 40PM <br /> 10. 4127 P. 2 <br /> � — � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERIVSIT SERVICES <br /> 3200 CEDAfl STREET, EVERETT,WA 98201 <br /> 425-257-8810—FAX 425-257•8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEP7ED FROM 8 AM TO 4 PM S �-�� —/z <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT 7! <br /> �112 �- e- D �� <br /> LEGAL LOT NO. BLOCK TRACT Ofl$UBDIVISION it <br /> DESC. <br /> OWNER ADDflE55 CITY2IP PhiONE <br /> 1��� �JP�n r1�.i� 1`112 Na�y�(4J e. �q gZc�{ �25 303 2 S�$ <br /> TENANT NAME I CONTAGT F R PERMIT ��^ON��.h �( _ <br /> �„ . !`J a"1 \O <br /> E�IAAIL <br /> GM�Gt�n In� ►415 Ra _ s EV °4g2o1 �kZs 2S9 (��ofo(t� <br /> CONTR.LI ENS R � M�� — <br /> �� <br /> USE OF BUILDING I T HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Elecirlc VGas_.,Olher �`�'�� r <br /> WORK AEBCRIPTION � <br /> �11S�G,1� �D.x�(�SS �-,'Zi� <br /> PLUMBING MECMANICAL <br /> N0. 7YPE OF Fl7(TURE OR ITEM NO. . 7YFH OF FlXTURE OR I7EM <br /> Toilet A/C—air handling units <br /> Balhtub _ Forced air systems <br /> Lavatory(wash basin) Gas p�pi�g <br /> Shower I N�a�er heater <br /> Kilchen sink&dispo9al Gas lireplace <br /> Oishwasher _ Gas ra�9e <br /> Clothes washer _ Clothes dryer <br /> � Water heater Range hood <br /> ^ Sink(serviceNarlmop/etc.) _ Exhaust fan <br /> 6ackflow prevenler ,_, Heat pump <br /> Urinal Unit hea�er <br /> � Drinking Fountain _ Boiler <br /> Floor drain _ Relrigeration <br /> Greasa lrap _ Woodstove <br /> Roof drains ,_ Other <br /> Olher — <br /> CITY�JF EVEpETf LOCAL SALES TA7(CODE IS 3105 <br /> I liereby coritily that I have reatl and examined this applicalion and know Ihe same to be lrue and corcect. All provisions o1 laws and � <br /> ordinacas governing ihis type ol work will be compliod wilh whether specitied herein or nol.The granting ol a pe�i�does not presume <br /> to give authority to violala or cencel the provision ol any other stale or local law repulafing consltuction or ihe pedormance ol <br /> conslruclion.That I am aulhorized by the owner of this propetly t0 petform ihe work}or whi�h application is made and:comply with tlie <br /> Stala Contractors Law 18.27 Rs.+�end 298.200 WAC. <br /> �� t�t�;a, IY��e,t.0 J�''�.��' <br /> Sipnature o nedContractor/Aulhorized Age Date <br />