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PtRMIT APPLICATION <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 ��U uG�O G. (� ,Z�/ <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT N <br /> ;r�� �vo��r�� q� �R �h �ro�t3�S � 3�3O°s� C�(o0 � l � <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. A '?�� �iV, n� IL f"t <br /> OWNER ADDRE55 CITY2IP PHONE <br /> �Ru p�vF�.oP,v�E,� 'F �c�S-rR-vrna., r � e�• ���1� , �✓ _ <br /> iENANTNAME CONTACTFORPERMIT PHONE <br /> N•iw lo+,S7sr.«cn,✓ ��ny�I ao(LcpU"l !Z�-Z'SL-l�-1f�Z <br /> CONTRACTOR � � V p� �y„�S� �� ADD E�S �k Z3ZL �ITY21P PHONE_ <br /> � v `�cY2o(, Y�C�- Z3 2-I y.42 <br /> CONTR.UCENSE# �.ppF Q C��� 2o G <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> /����� I _Electric ZC Gas_Olher <br /> WORK DESCRIPTION <br /> N�c.i �+P1.�.FK (�$F �✓.tsT� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF fIXTURE OR ITEM NO. TYPE OF FU(TURE OR ITEM <br /> �, Toilet AIC-airhandlingunils <br /> �t Bathtub Z Forced air systems <br /> _� Lavatory(wash basin) J` Gas piping <br /> Shower Waler heater <br /> � Kilchen sink&disposal � Gas fireplace <br /> � Dishwasher Gas range <br /> � Clolhes washer 2 Clothes dryer <br /> L Water heater Z_ Range hood <br /> Sink(service/bar/mop/elc.) 1,_ Exhausl fan <br /> Backflow prevenler _ Heal pump <br /> Urinal Unil heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Re(rigeralion <br /> Greaselrap _ �Voodslove <br /> ',Jj_ Roof drains _ Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined lhis applicalion and know the same to be lrue and correcl. All provisions of laws and <br /> ordinaces governing this typo o(work will be complied with whelher specified herein or not.The yranling of a permit does not presume <br /> lo c�ive authorily lo violale or cancel the provision of any olher slate or local law regulating conslruclion or lhe pedormance oi <br /> constructio�.Tha thorized by the owner of this propeAy to peAorm Ihe work tor which appiication is made and I comply with Ihe <br /> State lor Law t9.2 CW and 29�.200 WAC. <br /> -� '� 6_z2_ 4' . <br /> Signature wnedCon ractor/Authorized Agent Date � f <br /> �Z <br />