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1 <br /> + �—� - <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8657—www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �fj — a,�j�O� <br /> SITE ADDRESS PARCEL TAX I.D.q PERMIT# <br /> �•+ ;�• ���2To t_t Au� ��3Z O I t7�s �(�-c��-2 <br /> LEGA LOT N0. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> t'1Et.� � F�'�/-lCf��:"�' ?�}-�t^ I.k'�IZ-lJl�l, A\<c'!• �V'✓17(-'�il �fjLDl 71'C�a'41nj• �79'2� <br /> 7ENANT NAME CONTACT FOR PERI�MT PHONE 7�p�,i/�q y��j 7_ <br /> �l 7 <br /> Y�•U'I�� r-c�i�.�i#'#� EMAIL/SPn'.tcrr:t� �9A!,LI.i'c <br /> CONTR CTOR 11C�ru'p ,'r i9//Pp;iJyS DO ESS I 1 P ON <br /> J/ y 3�z cA�,�.�urfGru/�./� yZ5' �'L/-3T33 <br /> CONTR.LICENSEp y�R�,�� �y�oz mu(�'�f�� �"`k� ����'7'S <br /> �Z� <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> C�� <br /> "�. - � Electric _Gas_Olher � `"�/�-�- = <br /> Y-t�G-I 11l 'I.��'1� — <br /> WORK DESCRIPTION � <br /> i�il- ii�!:k,�.{1 C� � 1',,rn�aUt. ir,����-rI 1�r'W ��(i.S .�ilr/��l('�• , <br /> .li?'.1 ��l �ii�' �Lr:cr c�i�� �i Pi��U , <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF Fl%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet C-air handling units <br /> Bathlub Forced air systems <br /> Lavatory(wash basin) _ _ Gas piping <br /> Shower _ Water heater <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer _ Clothes dryer <br /> I Water hoaler Range hood <br /> � Sink(servicelbar/mop�etc.) Exhaus!fan <br /> _ Backflow prevemer Heat pump <br /> Urinal Unit heater <br /> Drinking Founiain _ Boiler <br /> Floor drain Relrigeration <br /> Grease trap _ Woodstove <br /> Roof drains Oiher <br /> Other _ — <br /> i CITY OF EVERETT LOGAL SALES TAX CODE IS�705 � <br /> I I hereby ceritity th I hace read and exa ' ed this app�ication and know the same to 6o ime and correcL All provisions ol laws and <br /> ordinaces govzminc� iis type of work will be omplied wilh whether specified herein or noL The granting of a permit does not presume <br /> � to qive au�hority to vio re oycancel the viei of any other state or local law regulating construction or the performance of <br /> iconstruclion.Th t I am Uih ized�by�owqer his property to peiform the work for which application is made �nd I comply with the <br /> State Contr�c Law 1 . RGW,and 296200 A . <br /> � ��� /`� !'_f=3 Oi� <br /> Signatu�,bi-0wner/Con torlAuthonze Agent Da� <br /> � <br />