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�-ERMIT APPLICATIUN � 1�, w� �� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 BQ� , � -a� <br /> 425-257-8810-FA;,425-257-8857-www,everpltwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �� `�' Ob <br /> SITE ADDRESS � �� — �� <br /> I�/�, � /,�Z/ /�Q� � PARCEL TAX I.D./ PERMIT�I <br /> LEGA LOTNO. g��K �A�i �U " OV�- <br /> DESC. <br /> OWNER ADDRESS <br /> �V'�QLT,C CITY2IP PMONE <br /> cn ��UuSI ►�N711c►Q�ty 3�07 �vla3� � �/ 33q-�vo� <br /> TENANT MAME � Ll`L=J��J'/ �(ZU� <br /> ICONTAC7 FOR PERMIT� PHONE <br /> CONTRACTOR QGV/(/P� ADDRESS Sy4N./L< CITY21p PHONE <br /> CONTR.LICENSE it <br /> USE OF BUILDING HEAT SOURCE <br /> �ps�����j�-���, �p�7�L CONTRACTPRICEOFWORK <br /> �u/3LI C.. /{(Jy5/ �C' _Eledric �_Other CI��v� <br /> WORK DESCRIPTION <br /> a u�ur �S /3u�e�-ed� iz Z� i.�7P,C�arC �' .�ix�r= 5 T�(t�c Tr,�.C� <br /> ���y izoa�= s 7�Pv�ru,C� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM <br /> N0. TYpE OF FI)CTURE OR ITEM <br /> / Toilet <br /> L Bathtub���1��'t _ aC-air handling units <br /> � Lavatory(wash basin) _ Forced air systems <br /> Shower _ Gas piping <br /> � Kitchen sink$�e� _ Waler heater <br /> Dishwasher _ Gas fireplace <br /> �, Clothes washer _ Gas range <br /> � Waterheater Clolhesdryer <br /> _ Sink(service/badmop/etc.) ✓ Range hood <br /> _ Backflow preventer Exhaust han <br /> _ Urinal Heat pump <br /> _ Drinking Fountain � Unit heater <br /> _ Floor drain _ Boiler <br /> _, Grease irap _ Refrigeration <br /> _ Roof drains _, Woodstove <br /> _ Other _ Other <br /> ---_. <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify thal I have read and examined lhis application and know the same to be true and correct. All provfsbns of laws and <br /> ordinaces goveming this type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other slate or local law regulatlng construction or the performance of <br /> canstruclion.T t am aulh rized by the owner of thls property to perfortn the work for which applicatlon is made and I comply wNh fhe <br /> State CoNr L 18. RCW,and 296.200 WAC. <br /> ������ 9/z/v� <br /> Signature of Owner/ConlractodAuthorized Agent Date � <br /> Cr7�vTr4C T y��/< .�j�,�/5 � 33 9-i�Y D.e �l2 <br /> � C�� yaa . y� �z, <br />