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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES �� _D� <br /> 3200 CEDAR STREET, EVERETT,WA 98201 �' '") <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org � <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM (`����'�� ��� <br /> SITE ADDRESS �'Cj ��°���'i�I (r�••1�Pi y pARCEL TAX I.D.# PERMIT il <br /> 'ya�OLC�DZ OG7SdU '� � <br /> LEGA LOT N0. BLOCK TRACT OR SUBDIVISION p <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> SI-�bL LLSfj (�.L��S Mc¢R��� �k �icwy GV�.2Lir .�y5 .qol •O1L1 <br /> TENANTNAME CONTACTFORPERMIT PHONE .�LS'"f31',O,Z <br /> � AM� �rf�li� �OPa1�� E-MAIL d4Vldh�o�nerCw�f�1.0 �"l <br /> C�ry7�'� q q I / I O <br /> ��r3 So�u'r� �'�5� LlL IDI.�i't �1t'?�H 4�t a� L�.ic.E STCJv^�S w� 913L $ <br /> CONTR.LICENSE p <br /> ��So�S�.. 934 gK �ZS•l37•�{OqL <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �Eleciric _Gas_Other ` � Z(��3L� — <br /> WORK^D�ESCRIPTION - 1 p a,� 7 \ � 1 <br /> reOJ�Dz NCW Yc+v7'Tbl� ,ry'tT lUw�� e,N� V�CTI�Ci �02 uP�"'� �4rLG <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet _ 1 A/C—air handling unils <br /> Balhtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas lireplace <br /> Dishwasher Gas range <br /> Clothes washcr Clothes dryer <br /> I _ Watcn c�ater _ Rangc hood <br /> Sink(service�barimoplelc.) � Exhaust lan <br /> I _ Backllow preventer _ Heat pump <br /> I _ Urinal Unit healer <br /> _ Drinking Fountain Boiler <br /> �� Floordrain Refrigeralion <br /> Grease trap Woodstove <br /> � Roof drains Other_ <br /> I _ O�her _ <br /> � — <br /> iCITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriiify iha�I have read and examined ihis application and know ihe same to be�rue and correcl. All provisions of laws and <br /> ordinaces goveming this type ol work will be complied with whether specified herein or noL The 9ranting of a permit does not presume <br /> to give authoriry m violate or cancel ihe provision ot any mher stale or local law regulating construction or the performance of <br /> construction.Thal I am authorized by ihe owner ol Ihis property to pedonn the work lor which application is made and I comply with the <br /> I State Comractors Law 1827 RCW and 29 200 WAC. <br /> A/� � _ Z�LSIoS <br /> � ��alure wn dConirac�odAuthonzed Agent Dat�— ��I�l <br /> � J <br />