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P�RMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT S�RVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 3••2 � <br /> --�--- <br /> SITE ADDRESS PARCEL TAX I.O.N PEFGAIT/ <br /> i % E O 0 O �v <br /> LEG LOTNO. BLOCK TRACT <br /> DESC. ,� <br /> OWNER ADDRESS CITY2IP iP as a3 c�s6�S <br /> �Q ��l <br /> _�(� /✓I'Z^ll��� NOL O/�II6 S GL L �y�S �80�'�s t� S c, s',uocr���sr� �i'f's�.9G-9&f3 <br /> iENANT NAME CONTACT FOR PERMIT PHONE <br /> /��s��^.Jreilr'To2 Gc G I �/4�e5 �irT�l/�5 �3�0� 7�/O -GL'� 7d <br /> CONTRACTOR DRES <br /> gFsrCGTMTRRGTbR'S��Y/N � �F���21t��/� Va7i 7�a -cn�� <br /> CONTR.LICENSE N � ,p1V L 2.� l�'s/UI1C/ � /� - ��VCJ _ <br /> �/� �Jt/�f <br /> USE OF BUILDINO HEAT SOUR CONTRACT PRICE OF WORK <br /> ��c/ �7 <br /> (5�� lC� �� _ElecMc _Gas_Other a (�v � <br /> WORKDESCRIPTION SC�d„EN �/4L,L /tN � G/f3'.�, D� ��7�� ����'v� <br /> 8u�d.� �n1G �p��o1� �/v rr co��„^�'"F-r !-IrGa F�C. <br /> �-4 U, r��'r SroK�1C-�E. <br /> PLUMBIN MECHANICAL <br /> NO. TYPE OF PI%TURE OR ITEM NO. TYPE OF FU(7URE OR ITEM <br /> Toilet A/C—afr hendlinp units <br /> Belhtub Forced air syatema <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplece <br /> Dishwasher Ges renge <br /> Clothes washer Clathea dryer <br /> Waterheater Range hood <br /> Sink(serv�ce/badmop/etc.) Exheuet fan <br /> BackBow prevonter Heat pump <br /> Urinal UMt heater <br /> Drinking Fountain Boiler <br /> Floor drain RefrigeraUon <br /> Grease lrap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7705 <br /> I hereby ceritlfy that I have read and examined lhis applicatlon and know the same to be true and carrect. All provlalona of laws and <br /> ordinaces gaverNng this type of work will be compiied with whether specifled herei�or not The grantlnp of a pem�it dost not preeume <br /> to give authoriry to violate or cancel the provisbn of any other state or bcal law reguladrp conatructlon or fhe performance of <br /> construction.That I am authorizod by the owner ot this property to perfortn the work for whlch applicatlon is made and 1 comply with the <br /> State Conlr ors Law 18.27 RCV�'a�d 296200 WAC. <br /> �.�.� 3�'��G7 <br /> Sig wre Q Ov�qer tr c or/ uthodzed Agent ^��1� � <br /> �''��� L <br />