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F��RMIT APPLICATIt�N <br /> CITY OF EVERETT 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 AA� TO 4 PM � s��� <br /> SITE ADDRESS PARCEL TAX I.D.# PERPAIT# <br /> � �n "1 J a c k sn�t �vE- rV O�C�-G�:b <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION i! <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> ` ��S <br /> G�ln�r-��a , � l- j ��'nGlri� �'s � `�Y''7 � rC ,C'.�cs�. ,���c'_ (=�c�r_' ff� ��f� "11b-9S5� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> E-MAIL <br /> CUivTRACTOF �r�2l�i Sc�� �-�-�o,�,°�ess! ,�IS ��� Si' sT�i�a LYNn;I:°fii�`A WA -��� <br /> `7' <br /> CONTR.LICENSEp I�1 ��i21S ��.� n /� � � Y2S �7/-�Y3Y <br /> � /��i <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric �� Gas Olher <br /> WORK DESCRIPTION � �S �L�� �t � � �-r-C G /� S F� �/�L.,4 Gi� G A'S <br /> 1z� Nbr� �.� s wAr� r+� �.� �o� r�,��� . <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR IT[M — N0�— TYPE OF FIXTURE OR ITEM _— <br /> Toilet NC-air handling units <br /> Balhlub Forced air syslems <br /> Lavaloiy(wash basin) � Gas piping <br /> Shower _,_ 1Naler heater <br /> Ki�chen sink&disposa! � Gas fireplace <br /> Dishwasher � Gas range <br /> Clolhes washei Clothes dryer <br /> Waler healer R2nge hood <br /> Sink(service/badmup/etc.) Exhaust(an <br /> Backflow provenler Heal pump <br /> Urin�l Unil healer <br /> Drinkinc7 Founlain . Boiler <br /> i _ Floor drain _ Refric�eralion <br /> . Grease lrap _ N�oods-love <br /> Rool drains 011ier <br /> CUier <br /> � <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby cerilify that I have read and examined lhis applicalion and kno,v Ihe same to be true and correcL All provisions of laws and <br /> ordinaces govoming lhis type of work will 6e complied wilh whether speci(ied hcrein or noL The yranling of a permit does not presume <br /> to give aulhority lo violale cr cancel lhe provision ot any other=_late or local law reyulating construclion or the periormance o( <br /> r,onslrucl�on. Thal I am authorized bq lhi�owner o(Ihis properly lo perform lhe work for�vhich application is made and I comply wilh the I <br /> Slale CoNractors Lan� 1t327 RCW a d�96.200 WAC. <br /> �� � � G�ts��2 �lr��� �C �i ��t_Cl' � �� .���-- C�,4 <br /> Signature f Ow dConlraclor/Aulhorized Ayen� Date <br />