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�CRMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org (,{(JS �j' ��O <br /> /OI 3 � ApPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM `l�SI� '.3� <br /> SITE ADDRESS PARCEL TAX I.D.A� PERMITN <br /> l0 M�eita�`c.�✓� AJ� C?�3f OG�Y157�C'.Y� ' S l� - � <br /> LEGAL OTNO. BLOCK TR�ACT n <br /> DESC. `� IJ'�O(iC�WI� l:Y'CS� S / - (7� <br /> OWNER ADDRESS CITY2IP P ONE <br /> Drer„M �', ��l� 1-.�� rt..uc �s�� n�*`A�E ,�. s�Olr,M,^sl. w,a q�z9v <br /> TENANTN E CONTACTFORPERMIT PHONE ' , <br /> � �:. � :�,. . I �TS•�-�: �,� y2s-a►�,oyiv :�� �� ., , <br /> C\ONTRACTOR ADDRESS CITY2IP PHONE <br /> W�cc..w. Cu�s�.vc�v�/. L',,yc . �t3lr �?7+nJu.,;�t1�C-., . S7c�nu,,,� <br /> CONTR.LICENSE# . •�_; �� � .. � .��� ���0 <br /> �YGW� �L..L'�{7SQL+ <br /> USE OF BUILD�NG I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> S�= �2 Electric �Gas Other <br /> WORK DESCRIPTION <br /> �Uew CUnS1��[.�-�k,r� Sr= � ����� <br /> �� �r� � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilet t!f A/C–air handling unils <br /> �_ Bathlub � Forced air syslems <br /> �, Lavalory(wash basin) 3� Gas piping <br /> �L Shower _L Water heater <br /> _L Kilchen sink&disposai � Gas firepiace � <br /> 1_ Dishwasher Gas range <br /> � Clolhes washer � Cbthes dryer <br /> Water heater �, Range hood <br /> _ Sink(service/badmoplelc.) �� Exhaust tan <br /> Backflow prevenler Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeralion <br /> Grease lrap Woodstove <br /> Roo(drains Olher <br /> Olher <br /> CITY OF EVERETT IOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y thal I have read and examined this application and know the same lo be lrue and correct. AII provisions o(laws and <br /> ordinaces governing this type of work will be complied wilh whether specified herein or n�t.The granting of a permit does nol presume <br /> to give aulhoriry lo violale or cancel lhe provision o(any other stale or local law regulating conslruction or the per(ortnance of <br /> conslruclion.Tliat I am aulhorized by the owner of lhis property lo pertorm lhe work for which applicalion is made and I comply wilh the <br /> Stale Coniraclors L� W and 296.200 WAC. <br /> �� /2-.�)-D.T— <br /> Signat ned ontracto Authonze nl Dale �� <br />