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( <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-6810-FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM I <br /> SITE AOURESS PARCEL TIU(I.D.i P RMIT N � <br /> 14� N�WI�fT" f��lE�l.U� oo�-3q �{,� �o�'o I �� L�v� - G�� <br /> LEGA LOTNO. I' BLOCK TRACT ,J <br /> DESC. �O � I NG. �� �' a �G� 2 <br /> OWNER AODRESS CITYILP PHONE <br /> NL�K�✓ �u\�Ci L�W I�7'�� T"�v'��'•�Z }4vL , �/C1 ,1� ISI�L�J��u� <br /> TENANTNAME CONTACTFORPERMIT p�� PHONE <br /> 7HE ►�JC-STic. Gh�� ,i�i� '���r�M�c.`�t��a,n t'i�)?s2-2►53 <br /> CONTRACTOR ADDRESS � CITY2IP PHONE <br /> ��.t,►�b G�4s'tR�1LT�ar�. �27 c.a.�Y �CV�• �V� °I0?�� ��) <br /> CONTRLICENSEi r �I� ' 1 COn� Z�iq� /sr� <br /> Y� (if� V � (�N7 <br /> USE OF BUILDINCa HEAT SOURCE CONTRACT PRICE OF WORK <br /> �jy-,-{ —�" 1� 00 <br /> '�"'�! I � I _Electric �Gas_Other �;/)�O `� <br /> WORK DESCRIPTION <br /> ��('A�b �TMdR,4t�.T' IN�Tn �'DJAC��NT '�N�.GZ' c,�!'�C.� , <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FI%TURE OR ITEM <br /> Toilet AIC—air handling units <br /> Bathtub Forced air systems <br /> _ Lavalory(vrash basin) Gas piping <br /> Shower Water heater <br /> Kichen sink 8 disposal Gas fireptace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryer <br /> Leundry Iray Range hood <br /> Sink(servicelbadmop/elc.) Exhaust(an <br /> Badcflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease Irap Woodstove <br /> Rool dreins Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS�105 <br /> I hereby cerifify that I have read and examined this application and know the same to be true and wrtect. All provisions ot larrs and <br /> ordinaces goveming Lhis type ot work will be complied with whether spedfied herein or nol.The granGng ot a permit dces not presume <br /> lo give authority to violale or cancel the rovision of any olher sWte or local law regulating conslruction or the peAortnance of <br /> consWdion.Th t I am autho ' d b owner o(this prope�ty to perTorm lhe work tor wfiich application is made and 1 comply with the <br /> Stale Contra rs Law 1 .27 W nd 9fi. WAC. <br /> g` w <br /> Sig at ofOwner/ o radoqAuthonzed gent Date � <br /> ` Z .. <br />