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PE�2MIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM T04 PM 7 �-S.A7 <br /> SITE ADDRESS PARCEL TAX I.D.N PE��T* ,�� <br /> %�f�2 o�4l�S A-�,� cn y 7S y-�ya -0/7-00 � 7Q � <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. /� �' / � � qO N/LTQV S SEGL�NJ� A�A'T� 'CY�1 <br /> OWNER ADDRE33 CITY2IP PM E �/d S -I$'Q - <br /> �'�o�r- ��I���,� /�E�NS /yab a�x�s A�� - ,�v��o7� �zo�i 3v3� <br /> TENANTNAME CONTACTFORPE'y�IT PMONE <br /> �v �{ I , corf- h��n5 Yzs-,26s-76q3 <br /> CONTRACTOR N � ADDRESS CIiY21P PHONE <br /> CON7R.UCENSEN �y/�. �y�M�OC�N� � ,�JCOTr /T��� <br /> ( <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �»�n �.ONC � <br /> J�� Electdc _Gas_Other Z,lrOQl <br /> WORK DESCRIPTION � � <br /> /��,>I�r�cr✓ rd S'Fi� - �1 f��f s�- �7' <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> I Toilet _ A/C-air handHng units <br /> j� Balhtub _ Forced air systams <br /> �� Lavalory(wash basin) Gas piping <br /> Shower Z Walerhealer <br /> / � Kitchen sink&disposal _ Gas fireplace <br /> � Dishwashor Gasrange <br /> /� Clothes washor � J� Clothes dryer <br /> Waler healer X Range hood <br /> Sink(service/bar/mop/etc.) � Exhausl fan <br /> BackOow preventer _ Heal pump <br /> Urinal __ Unit healer <br /> Drinkfng Founlain _ Boiler <br /> Floor drein _ Refrigeralion <br /> Grease lrap _ Woodslove <br /> Roof drains _ Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify Ihat I have read and examined lhis application and know the same lo bQ true and correct. All provisions of laws and <br /> ordinaces governing this lype of work wi�l be complied with whether specified herein or nol.The granting of a pertnil does not presume <br /> to c�ive aulhorily to violate or cance�the provision of any other state or local law regulating wnstruction or lho performance o( <br /> conslruclion.Thal I am aulhorized by lhe owner ot lhis property lo peAorm lhe work for which application is made and I comply with the <br /> Slate rac �Lay+�7,7�W and 296.200 WAC. � � �� o� <br /> �/ � S <br /> 6ippaWrc�of OwAedCo tractodAuthonzed Agent Date �/ <br /> Z <br />