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�rRMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FA:(425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �(� ���, —d„1� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT A <br /> 31�� ^'��v AV� � G � � �`-(3757 ooS �a U(a6 (v - <br /> LEGA LOTNO. BLO7CK TRACT N <br /> DESC. � � � 7> � � �,V ' ` CITY2IP PHONE <br /> OWNER ADDRESS <br /> �I�O DC✓f��FMt-'f � ��ST/Lurn� ��.G �?c. ��ic t23?(. � 9i�232-IHSz <br /> � <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> � ���w C�w��tri+�on,✓ `J�>N-� obo(LSv�Mf1 yZS- 2'> Z' lYBZ <br /> CONTRACTOR � �N � ��y,/5� �L ADDRESS� �X t232L CITY2IP c PHONE <br /> � t' �✓ �82 c. 42S-Z�Z- �yb'� <br /> CONTR.LICENSE# �0 m�C p G[��'L;�G <br /> r__„ <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> r7UPl�� I _Eleclric �Gas_Other �y � ��� Y� o O <br /> WORK DESCRIPTION ` <br /> /�1�1�1 ��(}1Li�C � L/1ST'� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> � Toilel A/C-air handling units <br /> �_ Bathtub � Forced air syslems <br /> _(� Lavalory(wash basin) � Gas piping <br /> Shower Water heater <br /> L Kitchen sink&disposal � Gas fireplace <br /> Z Dishwasher Gasrango <br /> �_ Clothes washer � Clothes dryer <br /> � Waler healer �- Range hood <br /> Sink(service/badmop/elc.) � Exhaust(an <br /> Backflow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinkinp Fountain _ Boiler <br /> Floor drain _ Refrigeralion <br /> Grease trap _ \Noodslove <br /> � Roo(drains _ .-'ther <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX COJE IS 3105 <br /> I hereby cerili(y Ihat I have read and examined this application and know the same !o be lrue and correcl. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whelher specified herein or nol.The granling of a permit does not presume <br /> lo give authorily lo violate or cancel lhe provision of any other slale or local law regulaling construction or lhe pedormance of <br /> conslruction.That I ain authorized by lhe owner of this property lo perform lhe work for which applicalion is made and I comply with the <br /> State C ors W and 296.200 WAC. <br /> � a1��__ b• Z2-�s� <br /> SignalurQ (Ow ed tre tor/Aulhonzed Agenl Dalo <br /> (�, <br />