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PERMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVI�ES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS P RCEL TAX I.D.� /� PERM� # <br /> zo ,� G�aNu q��'z ' aU�'o� � , <br /> �;�� ��/� 7 �� v? ��� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY2IP PNONE <br /> ��UC�[sc2T pfr�7c� Y, 3 � `( •-Co�Su <br /> �`i ZG�5 L R i�t�lVJ /�-i1� i._���t � � (.f,UF- <br /> TENANT NAME CONTACT FOR PERMIT PHONE Z 5 �j 7 z�� <br /> �� I ��UR �( Z ) <br /> E-MAIL <br /> ONTRACTOR AD ESS CITY/ZIP O <br /> G`�r�{-�'r� c i�i�i�,ac-� r?��c (zaqy r�,�ru��T .z�'t-7zso <br /> CONTR.LICENSE N <br /> USE OF BUILDItJG HEAT SOURCE CONTRACT PRICE OF WORK <br /> C'G�f�Ik-1Z _Electric _Gas_—Cther �U �`� �p�" <br /> WORK DESCRIPTION <br /> c�{C�SS i o�- /� l�t� 2G ZZ-� l» I l�c-\l�'l� G'�4�zUY,� !' <br /> /-��.��f - U�/ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel NC—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water healer <br /> Kilchen sink&disposal ^ Gas fireplace <br /> . Dishwasher Gas renge <br /> Clolhes washer Clothes dryer <br /> Nlaler healer Range hood <br /> Sink(sarvice/badmop/etc.) Exhaust(an <br /> Backflow preventer Heat pump <br /> Urinal Unil healer <br /> Drinking Founlain Boiler <br /> Floor drain Relrigera:ion <br /> Grease lrap Woodstove <br /> Roof drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby cerilify Ihat I have read and ezamined this appliwtion and know ihe same to be We and correcL All provisions of laws and <br /> orAinaces goveming this lype o(wcrk will be complied with whether specilied herein or noL The granting o(a permit does not presume <br /> to give aulhority to violale or cancel the provision of any othcr stale or local law rec�ulatin�conslruction or the performance of <br /> construction. That I am authorized by the ovrner of lhis pro��erty lo peiiorm the work for which applicalion is made and I comply wilh the <br /> S� '�racl'�aw 1 .27�2C'N and 296.200 l'VAC. <br /> �._ / ��.{_.'-^�--- `3 -1�, -O�(� I <br /> � SPg� GwneriConlrarlodiluthorized Agent Date <br /> � I <br />