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l <br /> � PERMIT APPLICATI N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810-�AX 425-257-8857-www.everettwa.org ✓�b 5- I/ � r <br /> APPLICATIONS ARE ACCEPTED FROA!18 AM TO 4 PM C lGd(i-(7 3 y <br /> SITE ADDRESS � p ;, J PARCEL TAX I.D.N P gM�T� <br /> ' c, >>�� f�e ���� w 1�Po• oos3l �lo��� ISoo - <br /> LEGA LOT NO. BLOCK TRACT OR SUBDMSION Nil <br /> DESC, y SI1of�' SUb�iJS�IY� 7�" 01• 73S <br /> pNMER ADDR CITY2IP PHONE <br /> �A��n;�f E�n� LL(_. I�o32 35i`' ►9v< St. lio'I�kl) yf(o12 NZS-�NS- I'I�i� <br /> 7ENANT NAME CONTACT FOR PERMIT PMONE �u="1"IS•I'1�$ <br /> I L�h �''�'H E�MIAIL <br /> w a a,r �.�+. L�� <br /> CONTR.UCENSE/ <br /> YiDAZRFL032(-1 I�u37 3S� pv�S� (iotncl� �jKUIZ yZS-lti3- )118 <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> SF{� I _Eledric x Gas_Other � ��U'� <br /> WORK DESCRIPTION <br /> s��z ��'��,r�Q ,�-« �41 �_� �n��� <br /> �'� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM NO. TYPE OF FIXTURE OR tTEM <br /> Toilet Q A/C—air handling unks <br /> � Bethtub � Forced air ey�tema <br /> � Levetory(wash basin) ,� Gas piping <br /> � Shower � Water heater <br /> � Kitchen eink&disposal � Gas fireplece <br /> 1 Dishwasher 1 Gas range <br /> T Clothes washer ,�, Clothes dryer <br /> � Water heater 1 Range hood <br /> 0 Sink(service/bedmop/etc.) L(- Exhauat fen <br /> O Beckflow preventer d Heat pump <br /> � Urinal O Unit heater <br /> G Drinking Fountain � Boiler <br /> � Floor drain O RefiperaHon <br /> � Grease trap ,� Woodetove <br /> �, Roof drains _ Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J106 <br /> I hereby certify that I heve read and examined thls application end know the same to be true and corred. A�I provisiona of lawe and <br /> ordinances goveming this type of wark will be complied with whether specified herein or not.The grandng of e permR 6cee not preaume <br /> to give authority ta vidate or cancel the provision of any other state or locel law rcpulatlng conatruct(on or the performance of <br /> conebvdion.That I em authorized by the owner of thfs propeRy to peAortn the work for which applica8on is mede and I compy with the <br /> Stete Conhadors Law SB27 RCW and 298200 WAC. <br /> ;�,.� ��tij�n .�. bl a91 � o <br /> Signature o wnedConfractodAuthonzed—Agent Date �/� <br />