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. <br /> P�RMIT APPLICATI(..�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everetlwa.org <br /> APPLICATIONS ARF ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> .��� li�Q�� VC � �510'�Z��l' <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> �^1i�1�S ` . .�/_ GAN ���y C1AL�L7 /�//F �/li77,�� /�J� �/1fL52 -/Sa�/ <br /> TENANT NAME CONTACT FOR PERMIT ` /' PHONE <br /> �iv,ti> �`5,4�++�n' �,�-un-,.J I d/���� Ructyei\`izs - �3y- 7a'7s <br /> CONTRACTOR�jjLv�)Y 5'T/�G���'%G4�G� � DDRES$ ��� �` ��,� CITY2IP PHONE <br /> � �'"P2� 3C--''' �l SE <br /> C�R.LICENSE# �'� �j Y� ,j,�c��n�. S�i CJ� <br /> �>ii/'��i � q���P 155���v�c ��z5� <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ' Eleclric _Gas_Olher //U hv� �� <br /> ���,�t7�}Gx — <br /> WORK DESCRIPTION <br /> ZJ� u Z�� �D�7L�.CI�t.t7 �/�I? L� UC <br /> PLUMBING MECHANICAL <br /> NO. TYPE OP FIXTVRE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water hea'er <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryer <br /> Laundry tray _ Range liood <br /> Sink(serviceibadmop/elcJ _ Exhaust fan <br /> Backflow prevenler _ Heal pump <br /> Urinal Unit heater <br /> Drinking Fo:ntain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains Other <br /> � Other — <br /> � <br /> � � CI OF EV�ETT LOCAL SALES TAX CODE IS J105 <br /> I hereby cer' i(y lhat I ha"ve read and e� ined t ` app!ication and know lhe same to be true and correcL All piovisions of laws and <br /> ordinaces g veming liis rype o(wo�c ill be mplied with whether specified herein or noL The granting of a permit does not presume <br /> to give auth riry to�vi late or cancel e vision of any other stale or local�aw regulaling construction or lhe performance of <br /> conslruclion.Th�t I a auth�r(zed ie owner o(this properry to perform the work for which application is maae and I comply with lhe <br /> Slate Contra' ors Law 8:17 R and 296.200 WAC. <br /> � <br /> �C� 7 OS <br /> Sc�nature of Own Con{tac rJAulho ' ed Agent Dale ��� <br /> \ 1 <br /> \ <br />