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( , i <br /> PERMIT APPLICATION <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 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.�► PERMITM <br /> o�s Mon�-r�e Avrnv� OrJ6" AD Zbo2 1ov CO�i[�-� g <br /> LEGA LOT NO. BLOCK 7AACT OR SUR�IVISION• <br /> oEs�. ,Z( ?3 026 P NEk't/�5 �dis o B <br /> oW�R �f ti1dr1'rrc �OzS�bnrac�it �3 �f25_ 353 2_L�J <br /> �OG6� y ti1ARuc � <br /> TENANTNAME ! CONTACTFORPERMR PXONEiL,r.3`�..�BO <br /> �iZMtC GtS 2GbUL c ��r✓ ,� r <br /> d.bvG �? �fur� e.�a / o •�f <br /> CONTA.LICENSE R ��� I �- J�• ��� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �'YMQ/y� 12G�,►crl �`�y34 <br /> ' / ����) �Electric _Gas_Other � � <br /> WORKDF.SCRIPTION � � � �J$> <br /> �?C�rreaE/ o� i 95o s s�i^rtefk r�. �9eu��/soa o��. J.� � <br /> /iv�i��space� �NC/r/dIN addr'frvna/ l�a.riir�r�, 6edr�o,�fsur,aor►r. <br /> SvbJ �h't0.5'�J�rG�tc{�G1 a� C�de L[ �e �e b�I�tc�r��'�� FT' <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF Fl%TUHE OH ITEM NO. TYPE OF fl)(TURE OR ITEM <br /> �Y Toilet A/C—air harWling units <br /> � Bathtub Forced air syslems <br /> Lavatory(wash basin) � Gas piping <br /> � Shower Water heater <br /> _ Kitchen sink 8 disposal / Gas fireplace <br /> Dishwasher T Gas range <br /> � Ciothes washer Clolhes dryer <br /> Water heater Range hood <br /> Sink(service/barlmopletc.) 3 Ezhausl ian <br /> Backllow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Relrigeration <br /> Grease irap _ Woodstove <br /> Roof drains _ Olher <br /> � Other���}�• _ <br /> 0 <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces goveming this type af vrork will be complied with whether specified herein or not.The granting ot a permit dcea not presume <br /> to give authoriry to vioiate or cancel the provision of any other state or local law regulating construction or ihe performzn�of <br /> construction.That I am authorized by the owner of ihis property to peAorm lhe work for which application is made and I comply with the <br /> State Contractors Law 827 WAC. <br /> Sig ure o r/ ontra or/Authorized gent at� � � <br /> / � <br />