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P�RMIT �PPLICATION <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 ANI TO 4 PM <br /> SI7E ADDRESS PARCEL TAX I.D.A� PERMIT N <br /> G��3 /��P/ n/10'1 _UIC� <br /> LEGA LOT N0. BLOCK TRACT OR SUBDIVISION K <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> l_c�is� FZic ��, (��3 ��e�rnse ���cf� ``6e�3 �/�5 -�v�- Ssy3 <br /> TENANT NAME CONTP.CT FOR PERMIT PHONE G�tS_ 75-y_:�n�a <br /> s�„� �.s �;h�N< �-« �;�r.�` <br /> E�MAIL <br /> I <br /> !.'cn��� Srn✓reS oF �rt�. eU• Sr13S Y4� �v� W. ,1i��k��}<p yls-�-`!U—/��0 <br /> CONTR.UCENSEp SJr 'G'� efr� S <br /> �_ <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> Sir���C 1�.�+����� ��� _� Electric _Gas_Olher --- <br /> WORKDESCRIPTION �„�✓C Iral:i..S walv I�talr.� a��d �-tplq[( <br /> � <br /> PLUMBING MECHANICAL � <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> __ Toilet A/C—air handling units <br /> BathWb Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Shower �i Waterheater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Water healer Range hood <br /> Sink (service�bar/mop/etc.) Ezhaust fan <br /> Backflow prevenler Hr.at pump <br /> Urinal U+iil healer <br /> Drinking Fountain Boiler <br /> Fioor dra?n F.efrigeration <br /> Grease trap VVoodstove <br /> Rooi drains (�ther <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TA7C CODE IS 3105 <br /> I hereby cerilify that I have read and examined this applicatirm and know the same to be true and correct. All provisions ot laws and <br /> ordinaces governing this type o(work will be complied wilh whelher specified herein or not.The granting o1 a permit does nol presume <br /> lo give aulhorily to violate or canrel Ihe provision of any othor stale or local law regulating construction or the peAormance of <br /> construction. That I am authorizea hy Ihe owner of this propery to perform the work(or which applicalion is made and I comply with the <br /> Slai�Conlractors Law 1�.27 fjC1h' A�id 296.200 WAC. <br /> ' � j /� <br /> : ,. . ' -� l �0>�07 <br /> Si uS ' f OwnerlContractorlAulhorize ' "�?ent ate <br /> , �, <br />