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PERMIT APPLICAT'ION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-881 U— FAX 425-257-8857—www.everettwa.org <br /> C/ APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � �'�Ou� ' O6Z <br /> �n � <br /> SITE ADDRES PARCEL TAX I.D.tt PERMITl1 <br /> ( ( ��L l�'���� r-��c0 c�R-'1 Oas379 Oc4� v�°z-vo <br /> LEGA LOTNO. BLOCK TRACT e/ <br /> DESC. �''Z._ ��/vlG �IL�D �� 2— <br /> OWNER ADDRESS CITYIZIP PHONE�e -406—/ 3 <br /> l,(/At Tz�z F y���- <br /> � ✓oQST//1< l''�r2 E: L,�S�{c�¢E r�2. ,C� S'2�„�s rd9, <br /> TENANTNAME CONTACTfOR PERMIT PHONE <br /> CONTRACTOR ADDRESS �� �Z�P 2"�E.�d G� �.Zi 3 <br /> Cc/jg«��� ��7n�f= /ra rn�-sc.C.L. (is�r /�go.%=� <br /> CONTR.LICENSE <br /> r�8� / �hi� ssc�13 <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> �Eleclric K6as_Olher <br /> WORK DESCRIPTION n � � /� <br /> /�1 ({�- � �> t� <br /> sL <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling unils <br /> � Bathlub � Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Z Shower Water healer <br /> � Kitchen sink 8 disposal Gas(ireplace <br /> � Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> � Waler heater Range hood <br /> Sink (serviceNar/mop/etc J Exhausl fan <br /> Backllow prevenler Heal pump <br /> ^ Urinal U Unit heater <br /> Drinking Founlain _ Boiler <br /> � Floor drain _ Refrigeration <br /> Grease lrap _ Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby ceritify that I have read and examined this application and know the same lo be true and correct. AII provisions of laws and <br /> ordinaces c�oveming this type o(work�vill be complied with�vheUier speci(ied herein or not.The granting of a permit does not presume <br /> to give authoriry to violate or cancel the provisicn ol any other state or local law regulating construction or ihe pedormance oi <br /> construction.Thal I am authorized by the owne 'oi ihis property to perform lhe work(or which application is made and 1 comply with the <br /> Stat CoNract rs La� 8. 7 RCW and 296. WAC. <br /> �t%��� i�,�t/J-�� � 3 �l '1�0 ( <br /> Signature of OwnedContraCtor/Aulhorized Agent Date �/Z. <br />