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I <br /> PERMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-wuvw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS , PARCEL TAX I.D.M PERMI� _�/ �J <br /> /O/cQ! �E i /^ CC U "O ' DO00 00 � � � <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE� �-a/73'�OS�OG <br /> 7'nC�/y✓le � ��='at t�avlaa v�a 3- �I ) �,�/ SPo /tle t� //��/ Sn�io�cr� Y8a4/e <br /> TrNANT NAME CO ACT FOR PERMIT PHONE <br /> ao6-na1-.�aBG <br /> I�e�tU/' .S'Pa dJ�i� 3�aG [.�p�la�..��✓�c Que ,(�.S'e�{'/�/!� 9p(03 <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# �CGFo�c99ol�s <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �(Electric _Gas_Other ,;, '7 736./0 <br /> WORK DESCRI�PTION � � , f , �0�,�,,� � a,� <br /> ._�PtiL�,I��` CY�� ..��Gl.W77 ��il/-Lu/a�"_ � /„Grw�.u�N � �!"�^^'��- <br /> AQ� � .7�.d,:��.j C <br /> .�� <br /> PLUMBING MECHANICAI. <br /> NO. TYPE OF FIXTUR[OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> / Toilel A/C—air handling unils <br /> r Balhlub Forcedairsyslems <br /> / Lavalory(wash basin) _ Gas piping <br /> f� Shower Water heater <br /> 1_ Kitchen sink&dispusal _ Gas fireplace <br /> Dishwashc+r Gas range <br /> _L qolhes washer � Clothes dryer <br /> / Water healer � Range hood <br /> Sink(service/bar/mop/etc.) _ Exhaust fan <br /> BackOow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinkinc�Fcuntain Boilet <br /> Floor drain � Refrigeration <br /> Grease trap —� Woodstove <br /> Roof drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX COUE IS 3105 <br /> I hereby ceritify thal I have read and examined this application and know lhe same lo be true and correct. All provisions of laws and <br /> ordinaces goveming this rype o(work will be complied wilh whelher specified herein or noL The granlinq o(a permit does nol presume <br /> to give aulhority to violate or cancel the provision of any other slate or local law regulating construction or�he performance of <br /> conslruction.That I am aulhorized by the owner ot lhis property to perform lhe work tor which applicalion is made and I comply with the <br /> Slate onlraclors Law 27 RCW and 296.200 WAC. <br /> � //J(/Yl���Lf��/UG�/(O/� �"'����r/ <br /> Signature ot OwnedConiraclod thorized Agent Dal <br /> ;�GF'j �S <br />