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PL�r�MIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERE iT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT�CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.M p ��* <br /> (o �L O.4k�y /�:,c:- zqosl7 oa z�s,oc� SOZ �8 <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP P ONE <br /> �A2iG �-1_FGH'ry lQ3Z D/11��5 ,4v� EVE� 2ab94&�ySo <br /> 49zo J <br /> TENANTNAME I CONTACTFORPERMIT PMONE <br /> � <br /> CONTRACTOR /k[ i FC C-�q,24�gS /iv(. ADDRESS 'L72(� 2,�L{c� CITy21P PHONE <br /> CONTR.LICENSE N P�C/�) �t.R.{'� (�'}j "jA 1 <br /> �i i o���.� yz�-asg-i 3�/ <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �a/-#2�6� NvN�- <br /> _,Electric _Gas_Other /3 �pb , �J <br /> WORK DESCRIPTION <br /> l�ti sm� �; �a �� G4���� /���,r� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FD(TURE OR ITEM <br /> _ Taiiet _ A/C-air handlfn units <br /> Bathtub 9 � <br /> — Forced air systems <br /> _ Lavatory(wash basin) Gas p(ping <br /> _ Shower Waterheater <br /> _ Kitchen sink 8 d(sposal _ Gas flreplace / <br /> _ Dishwasher Gasrange <br /> _ Clothes washer Clothes dryer �/ <br /> _ Laundry tray Range hood <br /> _ Sink(service/bar/mop/e .) Exhaustfan <br /> _ Backflow prever.ter Heat pump <br /> _ Urinal Unit heater <br /> _ Drinking Fountai Boller <br /> ,_ Floor drain Refig Uon <br /> _ Grease trap Woodstove <br /> _ Roof drains I Other <br /> _, Other — <br /> I <br /> C�TY OF EVERETT LOCAL SALES TAX CODE IS J10S <br /> I hereby ceritiy that I have read and examined this applicatlon and know the same to be true and correct. All proWsbns of laws and <br /> ordinaces governing this type of work will be complied with whether specifled herein or not The grantlnp of a permit does not presume <br /> to give authoriry to violate or cancel the pravision of any other state or local law regulatlng constructlon or the perfortnance of <br /> � construction.That I am authorized by the owner of this property to perform the work forwhich appifcatlon is made and I comply with the <br /> State C�to��7 RCW and 296.200 WAC. <br /> � �' �! ZZ(�� <br /> SignaNre o wner/ ontractodAuthonzed Agent ate <br /> �IZ <br />