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i <br /> PERMIT 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 Alll�TO 4 PM � �I 'a —� � <br /> SITE ADDRESS PARCEL TAX I.D.N PEftMIT�Ji� , � <br /> � 30 � /��c�/=�c �9� �- "l <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP FMONE <br /> LO 2J/Z� /3 0o z -�%T�.` ;T. .�v. �, 3(� u —�c�/ '� 3 3 <br /> STEv� r� ��,��� �r�..-.,�, c.A ra z�- — y <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> y zs 35 3�r�� <br /> J�iC G1���75�����1rrGvs �/�C/=G/lll?l�:-��s�</� �1i o�n9,�7� <br /> CONTRACTOR �—�L,yy„� ,1—�,Ij�sJ�'J/(*S AD�RESS CITVIZIP PHONE <br /> ���� 2o�t12 ✓vG 7S"�` �t • <br /> CONTR.LICENSE A' �2 S ���� 7 7�Z <br /> 7'�a���7.��'D7 >/�9 2G-1�/�0-✓� ti9 �Sf�3'� <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> i <br /> (��p�•ti�� �r�lN�yf/��- _Electric _Gas_Other /� � ; ��-7 <br /> � <br /> WORK DESCRIPTIUN <br /> /J NJiJ7G'v/IZ LC�/,i �7/ G)� /�/�-G✓7� /3G G � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE 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 heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Lau�dry tray _ Range hood <br /> Sink(servicerbadmop/etc.) _ Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain _ Boiler <br /> Floor drain Refngeration <br /> Grease trap Woodstove <br /> Roofdrains � Other�/JS�//rdo�)� ��/��G `� <br /> Other <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 1105 <br /> II hereby ceritify that I have read and examined this application and know the same to be true and wrrect. All provisions of laws and <br /> ordmaces goveming this type of work will be complied wdh whether specified herein or not. The grenting of a permit does not presume <br /> to give authoriry to violate or wncel the provision of any other state or local law regulating construction or the performance of <br /> constructioa That 1 am authorized by the owner of this property to pertorm the work for which application is made and I comply with the <br /> State Contr rs�La 8 27 R 96.20G WAC. <br /> .- ,/`��:����� %' ' /2 -�7 <br /> �hetGr�of OwnedContractoUAu honzed A9ent Date �1� <br />