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PE�iMIT APPLICATI <br /> � �� � � <br /> CITY OF EVERETT PERMIT SERVICES 1 `� �dQg <br /> 3200 CEDAR STREET, EVERETT, WA 9�201('i;; �,,:;., <br /> 425-257-8810-FAX 425-257-8857-www.ever�lfWa:org;,;, .;,.,�`' `='r ; <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � _����� <br /> /2�0/"� <br /> SITE ADORESS <br /> n PARCEL TAX I.D.7f PER X <br /> � M � �v. � ��Zo� a�, �oo �3�' �( Z. - n��l <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY/ZIp I�HON �Z <br /> �a��...-� 1-1�;<< � � m�,..�.�r Ja�� ��.-� G���� ��� ����z <br /> TENANT NAME COHTqCT FOR PERMIT <br /> PHONE �+V 1��-�jr�� <br /> co rn r��� �,p�.�t� (.�/.[h.S�/� e-MaJ7c7�"Gacf/.�<</ 6ccQ ,��ry„ <br /> mm <br /> � Y� � <br /> I.U�:S h��v�� j,().oj�c; a �5 /�S�fO ✓Z��ha,�, Jlt�� i� �SOZ�- <br /> CONTA.LICENSE RGL��SN I��/�iSO Q� � <br /> /?�</(e�ue j,�Xr %�'cr�� 176-`655� <br /> USE OF BUILDING EAT SOURCE I GONTRACT PRICE OF WORK <br /> NY� �!�- � <br /> _ ectnc _Gas_O�her � 7v � <br /> WORK DESCRIPTION O�Cy� I ��I 1 C�� %`� �J` / �`�L <br /> �-!'l.'f � � �L�.rL <br /> PLUMBING MECNANICAL <br /> NO. TVPE OF FlXTUqE OR ITEM NO. TYpE OF flXTURE OR ITEM <br /> Batlhtub NC—air handling units <br /> _ Lavatory(wash basin) _ Forced air syslems <br /> Shower �r- Gas piping <br /> _ Kitchen sink 8 disposal ___!_ Water heater <br /> _ Dishwasher _ Gas lireplace <br /> Clothes washer _ Gas range <br /> _ Waler heater _ Clothes dryer <br /> _ Sink(scrvice/badmop/elc.) _ Rangc hood <br /> Back�low preventer _ Ezhaust lan <br /> Urinal _ lieat pump <br /> Drinking Fountain _ Unit heater <br /> Floordrain _ Boiler <br /> _ Grease Irap _ Refrigeration <br /> Roof drains _ 1Noodstove <br /> Olher _ Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritity that I have read and examined Ihis application and know the same to be tme and conect. All provisions of laws and <br /> ordinaces governine�Ihis type of work will be complied with whelher specilied herein or not.The granting of a permit does not presume <br /> lo give aulhority to violate or cancel Ihe provision ol any other state or local law regulating consiruction or the pedormance of <br /> construction.That I am authonzed by Ihe owner ol this pmpeny to pedorm the work lor which appiication is made and I compiy with the <br /> State Contractors Law 7827 RCW and 296.200 WAC. <br /> C..�.9.. �.,�- ���l� 4 � i o , <br /> I Signature of Ow IConiraclod ythonzed Agent Date <br /> L �-- <br />