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PErtMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.N PERMIT M ' <br /> 230� E. �RArD A�E c� (�2� SlU o2� OC� '.� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. �� 30 3� '3'Z- -ril0 l� � UN�dt�1'i'2�1SZ' �'A �5? (�O� �� �rdJ1'd.Z� <br /> OWNER ADDRESS CITY2IP PHONE <br /> {l,r��.� �cA--�� `�t�� 154,-irJ �'�s.F_ SNaaow�s�-� 425�330�`'i � I�t <br /> TENANTNAMG CONTACTFGRPERMIT PHONE <br /> 1<F�.�y �t�q-i►a 42�•33�'�11�`t <br /> CONTRACTOR i) �.�1 u U�M.�S ��L ADDF.ESS CiTY21P PHONE <br /> 'ST <br /> CONTR.LICENSE N��.���_,��,�� -7�1 � C��� �.$�_ � . 42rj'3'���t� �9 <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> S1 i� x Electric _Gas_Olher �� O Gt7 � <br /> WORK DESCRIPTION II <br /> �Y w1oU'l�ot,l b� �•s�L=x <br /> — PLUMBING MECHANICAL <br /> N0. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handling units <br /> BalhWb Forced air syslems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Waler heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer _ Clothes dryer <br /> Water heater Range hood <br /> Sink (service/badmop/elc.) _ Exhaust fan <br /> i Backflow prevenler _ Heal pump <br /> Urinal _ Unit healer <br /> Drinking Founlain _ Boifer <br /> floor drain Refrigeration <br /> Grease Irap _ Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> i hereby ceritify that I have read and examined lhis application and know lhe same lo be lrue and correcL All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or not.The granting ot a permil does not presume <br /> to give aulhoriry to violate r cancel the provision of any other state or Iocai law reguiating construction or lhe performance of <br /> c nstruction.T I a i eu orized by the owner of this propeRy to perform lhe work tor which application is made and I compiy wilh the <br /> S te Conl ors La�B. 7 RCW and 296.200 WAC. <br /> ��, I t� -<o-O� <br /> Signature o(OwnedC nlractor.�Authonzed Agenl Date <br />