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i <br /> PE MIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES 3� a3--o n <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org '�)����L _J � <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> S � I� Cqq /�pK,T��tl /W� �,� �i� �? �,�-, ,��` <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> PR� ��Prs�F�r � GauS"r�ucn�n� p b. P�x i Z3z� � �z��i3 z � `�8 Z <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> Na�� I JoKn! oGo�S�c.K/i c,/ZS � Z32- � `lsZ <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# ��DCR� Zo�- <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> MuL� f�qrT4iL7 Electric Z( Gas_Other <br /> — �4�G� /j�— <br /> WORK DESCRIPTION <br /> � <br /> ill1�c.J i�u(�t r x — i_fl�=,'t_ /-� ��7'vr—}� <br /> t <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> L� Toilel A/C—air handling unils <br /> -�� Balhtub �. � Forced air syslems <br /> y Lavalory(wash basin) ;� Gas piping <br /> Shower �� Waterhealer <br /> = Kilchen sink 8 disposal �,� Gas fireplace <br /> �_ Dishwasher Gas range <br /> Z Clolhes washer �. Clolhes dryer <br /> �_-Water heater <--� Range hood <br /> Sink(service/badmop/etc.) `�{'Yn� Exhaust fan <br /> Backllow preventer _ Heat pump <br /> Urinal Unit healer <br /> Drinkinc� Fountain _ Boiler <br /> Floor drain Refrigeration <br /> � Greaso trap _ Woodstove <br /> �_ Rooidrgins _ Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify Ihat I have read and examined lhis application and know lhe same lo be true and correcL .411 provisions oi laws and <br /> ordinaces governing this lype o(work will be complied wilh whether specified herein or not.The granling of a pemiil does not presume <br /> lo give authonty to violate or cancel tho provision of any olher state or local law regulating consWction or lhe pertormance of <br /> construction.That I am aulhorized by lhe owner of this property lo pertorm lhe work for which appiication is made and I comply wilh lhe <br /> State Co ctors�L�a�v 18.2�7 RCW and 296.20U WAC. <br /> ---C` L��--- Z-�?-v�. <br /> SignaWre Ow or/ nlratlor/Authonzed Agent Date � <br /> �� <br />