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�ERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810-FAX 42!�•257-8857-wvuw.everettwa.org <br /> APPLICATIONS ARE ACGEPTED FROM e AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 14�1 �G�c- OOE�-t cvoot�c�loo '�abo�-o�0 <br /> LEGq LOT NO.� I O BLOCK TRacT <br /> DESC. <br /> OWNER l.1. ::2E53 GfTY21P PXONE u�5'„ ' <br /> F F ��n�r- L,� l9uo� 40�+� w. S�x� � ��,°�3� ce�o 9ati�. <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> FF 0 L� P � �«vA 4z� 3�a -wa� <br /> CONTkACTOR Ulxylq�. yK,�J(p ►JC, ADDRESS CITY2IP PHONE <br /> ,.•.-_'-� abto3 Wa+�-S�H R� N� n <br /> CONTR.UCENSE M WR701M�IA.�� �OYL "1�'J - ��ll '�S� <br /> nr.�.w�P�l�l�_�P, <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> ���'�^,yq.�� V Electric �Gas_Other <br /> WORK DESCRIPTION <br /> �wr►�.P,i�1ca . . N�W ��wu-�o�.► �►�n�.,-����..� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FlXTURE OR REM N0. '�YPE OF FUfTURE OR I7EM <br /> Toitet A/C-air handling units <br /> �O Bathtub Forcod alr systems <br /> �O Lavatory(wash basin) � Gas piping <br /> Shower � Waterheater <br /> � Kitchen sink 8 disposai � Gas fireplace <br /> I�o Dishwasher Gas range <br /> ib Clothes washer � CloNes dryer <br /> yl�� Water heater Range hood <br /> Sinh(servicelbarlmopletc.) Exhaust(an <br /> ' Backflow preventer � Heat pump <br /> � Urinal Unit heater <br /> Drinking Founfain Boiler <br /> Floor drain —' Refrigeration <br /> Grease trap Woodstove <br /> + Roof drains ^ Olher <br /> � Other <br /> CIT'OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that i have read and examined this applieaUon and know the same to be we and eorrect. All.provlsions ot laws and <br /> ordinaces 9oveming this type of work wlll be compiied with whether specified herein or not. The g2nting of a pertnit does not presume <br /> to give autho�i lo violate or cancel the provislon of any other state or local Iaw r,gulating construction or the perfortnance of <br /> co�strudion at I am a o ' ed by the owner of lhis property to peAorm the vrork for which application fs made and I comply with the <br /> State Con rs law 1 CW and 298200 WAC, O <br /> •i`-=--- ! („ 0 (o ,b� <br /> Signa e o er on ctor Authoriza0 Agent ate p� <br /> � <br /> � , �v <br />