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^ � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810-FAX 425-257-8657-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM y � a3 -�U <br /> SITE ADDRESS PARCEL TAX I.U.# PERMIT N <br /> 0733o cG. � �'cw.9 Avc oo mz - od /vl /Oo -U <br /> LEGA LOTNO. BLOCN T�RAnC�T�ORSUBDIVISIONM (� <br /> DESC. I -F'I�/V ZO wYl. \ /LlJ_A� C 0• S. I�'�C�-�d-. <br /> OWNER ADDRESS CITYI2IP�is�' PHONE <br /> So.� Le /�d�„�ct� �.i��'�4 -�3s"� �_ 6ra.,.� A�c �u�.n,._�' �/u'�9- ot.s <br /> TENANT NAME CONTACT FOR PERMIT PHONE �ob_�u_ �y 3/ <br /> ��Ne � ,(R�Y So�. e.Ma� sIQiS9 Q � t o�o.cb <br /> <'-�d�.�_ . -J ,1,�_s.�-t,�.t��- �lo5ar ��-t �S�o� ��.,,,�.-t� 7�5 5s3 ry � <br /> CONTR.LICF.NSE M �_I-Z_I L <br /> /'-� A .ts+a.-►�t � U �l 3 '� �-1 � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Electric _Gas�Oth2e��� <br /> WORK DESCRIPTION <br /> ��T""`- Q�'U�(�,�� � I� P �—� <br /> ` <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FIXNRE OR ITEM NO. NPE OF FIXNRE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air syslems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal � Gas Greplace <br /> Dishwasher Gas range <br /> C�olhes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/barlmop/etc.) Exhaust fan <br /> BackAow prevenlcr Heal pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeretion <br /> Grease trap Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J705 <br /> I hereby certify that I have read and examined this application and know ihe same to be true and correct. All provisions of laws and <br /> ordinances governing this type of work will be complied with whether specified herein or nol.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construction or the peAortnance of <br /> construction.That I am aulharized by the owner of this property lo peAortn Ihe work for which application is made and I comply with the <br /> Sta�t ontradors Law 18.27 RCW and 296200 WAC. <br /> l I�! 'n rt �,n � ��� �/-L3 /,O ' <br /> SignaWre of OwnerlContractodAuthonzed Agent Dale <br />