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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 ll— g�� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.p PERMIT� <br /> i�?z�� E M��Z�,u� l�i �r_ a��-�k3��9���� � �l� <br /> DESCL LOT NO. � BLOCK TRACT OR SUBDIVISION N �1���� ��U- L'� �'�"��T <br /> �� ,--29-��� �� <br /> OWNER AD�RESS CITYIZIP PHONE <br /> ��l��L- G���,u ,y��,u5`r,�����c,c� �z� x�x i��� MPryv-�ll� �3�� <�.�-�-s�,� <br /> TENANT NAME CONTACT FOR PERMI PHONE �3GG'-�I S�i �`J�=��7 <br /> �f'S'S�I��� �/�!�C.�.�J" E.Ma��CfHGJiCS���JJ/Y%//!i � <br /> Z�-���Z G G l.t,�'r/'G� ���%S r�'G.��I71�' 13G�0 - �4.�� �"/�7 <br /> CONTR.LICENSE# ���/���. /L' ��� , /� <br /> L L /V <br /> USE OF BUILDING ,� � I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �,5�� Eledric '� Gas Other <br /> WORKDESCRIPTION ��, ��/�� y� !v7/� �� �,` � _ �I� `�� `��� <br /> �� � / / �7(J � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXNRE OR ITEM <br /> Toilet !VC–air handling units <br /> Bathtub Forced air systems <br /> -t Lavatory(wash basin) � Gas piping <br /> � Shower � Water heater <br /> � Kitchen sink 8 disposal � Gas fireplace <br /> �_ Dishwasher Gasrange <br /> I Clothes washer ,� Clolhes dryer <br /> � Water heater � Range hood <br /> Sink(service/bar/mop/etc) T� Exhausl fan <br /> BackOow preventer Heat pump <br /> Unnal Unit healer <br /> Dnnking Fountain Boiler <br /> Floor drain Refngeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TFJ(CODE IS 3105 <br /> I hereby certify that I have read and examined lhis application and know lhe same lo be Irue and correcl All provisions of laws and <br /> ordinances goveming this type of wnrk will be complied with whether specifed herein or not.The granting of a permit does not presume <br /> to give authonty lo violate or cancel the provision of any other state or local law regulating wnstruction or the perfortnance of <br /> ruclioa That!am auth zed by lhe owner of this pr perty to perform the vrork for which application is made and I comply with the <br /> Slate ntractors Law 18.27 CW and�962 )W <br /> � � " � /�� � ' ��� G���� •�� <br /> /Signa re of Owner/CO ctod uthonz A nt Dale � <br /> � � � � <br /> \ Z <br />