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PERMIT APPLICAT;ON <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 —FAX 425-257-8857 - www.everettwa.crg <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS <br />PARCEL TAX I.D. p <br />PEgg��++f�T p n <br />D 1Vh_ <br />00 8- 36Lbz700 <br />C�7z13 <br />LEGALL LOT NO. <br />DESC. _ L S? <br />BLOCK <br />6 2 <br />TRACT ` /� __ <br />L 1/'S k E/ Dulls l DW <br />OWNER ADDRESS CITY/7.IP PHONE <br />i26hC,-T/g10 RAlN/Ue £V£'RLF i Z115-=2S 9- 3c/7S <br />TENANT NAME <br />CONTACT FOR PERMIT PHONE <br />O(j)A// k Ce y� ~ r zr9— 7 y7S_ <br />CONTRACTOR tJDA9L OIJNEIe ADDRESSS I+?� CITY2IP PHONE S qmt: <br />SA3rT <br />CONTR. LICENSE q <br />Nl <br />USE OF BUILDING <br />HEATSOURCE <br />i PRICE OF WORK <br />�L>/(/�%✓l ��/� <br />_Electric �Gas_Other <br />N1�1 g00, .ry— <br />WORK DESCRIPTION <br />jNSTRG` r£xT1t�cs TO Gvnr£/E�r �'S/L�l bc7,�ni <br />_ <br />40 A /bATI/ /ZDOf�t, ND J_krCleiO(R U'ALLj CN141v6-CO r /V,; R0(,F C)14N9,�/I <br />SI/itviR Tci�G% � Sin/i< WeL 5Omir <br />f <br />//115TA1-1ArlE✓ 0r hgTyrTtyda <br />�p eHn�crc <br />sju, rzelet��s_ v� <br />PLUMBING <br />MECHANICAL <br />NO. TYPE OF FIXTURE OR ITEM <br />NO. TYPE OF FIXTURE OR ITEM <br />J_ <br />Toilet <br />AIC — air handling units <br />1— <br />Bathtub <br />Forced air systems <br />_L <br />Lavatory (wash basin) <br />Gas piping <br />Shower <br />Water heater <br />_L <br />_ <br />Kitchen sink & disposal <br />_ <br />Gas fireplace <br />_ <br />Dishwasher <br />Gasrange <br />_ <br />Clothes washer <br />Clothes dryer <br />_ <br />Laundry tray <br />Sink(servicebar/mopletc.) <br />Range hood <br />Exhaust fan <br />_ <br />Backflow preventer <br />Heat pump <br />_ <br />Urinal <br />Unilheater <br />Drinking Fountain <br />Boiler <br />Floor drain <br />Refrigeration <br />_ <br />Grease trap <br />Woodstove�l <br />_ <br />Root drains <br />Other l <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />1 hereby ceritify that I have read and examined this application and know the same to be true and m roct All provisions of laws and <br />ordinates governing this type of work vnll be complied with whether specified herein or not. 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 performance of <br />construction. That I am authorized by the owner of this property to perform the work for which app'.ioation is made and I comply with the <br />state ntracctto�rs� Law 18.27 ROW and 296200 WAC. <br />) <br />Ownar/G <br />Sign lure of r/Avtrto+ru+C7riJW1t Date <br />