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PERMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D./ PERMIT� <br /> �32� [�c '%M�ic Q/� lj���6'T 0�3 OJoOo ,bZa o <br /> i� 06 - <br /> L6GA LOTNO. BLOCK TRACT LZl�'QA2/c /'_' 9D9 5'LKOUO D-/- SSS` L o7 C-2 AcL �LOj <br /> DESC. Z 4 - /"�CnD�o� G3 �' T.Fcv S.3S/�T L 79 fk S� of�„qY �k7J3yipo / <br /> OWNER ' ADDRESS CITY2IP PHQNE !/,r.�J�_ <br /> �i�.l� �R-�L �2o�1�TT�; c c� Z r7�' �Ycd�c- 02 . G� 9�Zv� '��Z�i <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> f�q-L .?l�`� I lr+�?( S l�i(S�f �2f=3U��z- 7/ <br /> CONTRACTOR �-���/t/�JQL� /Ic�`jF/l�FN� �DRESS CITY2IP PHONE <br /> s��.s�rr�f-�+� Ev<�7z�.�r98zo/ �Za6 -7p3-- /3z/ <br /> CONTR.LICENSE��F(�fI I ��L-C-r <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> (7-S�S��J�`� �-L ✓Eleclric Gas Olher �? S�r� ^ <br /> WORK DESCRIPTION ��rn�U �^rIS� _ P���� F �2 ��l✓ PG��-- <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXIURE OR�TEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> � Bathtub Forced air systems <br /> V Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> V Kitchen sink&di�petiel Gas fireplace <br /> Dishwasher Gas range <br /> ✓ Clothes washer Clothes dryer <br /> �! Water heater Range hood <br /> Sink(service/badmopletc.) Exhaust fan <br /> _ Backflow prevenler Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> _ Floordrain Refrigeration <br /> Grease trap Woodstove <br /> Root drains Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3705 <br /> II hereby ceritify that I have read and examined this application and know the same to be true and corred. All provis°ons of laws and <br /> ordinaces goveming lhis type of work w;ll Ne complied with whother specified herein or not.The granting of a pertnit does not presume <br /> to 9ive aulhority to violale or cancel lhe orovision of any other state or iocal law regulaling construction or the pertortnance of <br /> construction.That I am authorized by the owner of lhis property to perform 1he work for which appl(cation fs made and I comply with the <br /> State Contrac rs Law 18.27,RCW and 296.200 WAC. <br /> / i { <br /> ���% ..- �l� �- ?3-�G <br /> Signalure o(Owner/Con�actor/Authorized Agent Dale <br />