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P RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 =' "G �� <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org � � V 0 ^ <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM F.O �o ( D 'U� 7 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 1a�o �,a�c cb �ic-o�ovB�o �—'�'r <br /> LEGAL LOTNO. � BLOCK TRACT <br /> DESC. s� 1�t, a�E��p <br /> OWNER ADDRESS CITY2IP PHONE <br /> �1•�.� —t, ,t�s � ���c a�s�,��! <br /> TENANTNAME � CONTACTFORPERMIT y� 13 PHONE <br /> Tur�3s l DuFsr�1B�. �� ur� tr t�K� �ALsIF/ �Z s d�3- s6s1 <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> ADJAucro �F�a.� Q¢oZECTorI , P.o. (3or �sq 3 w�,M,��c�, wa q�o�z �zs- 4s3�s�.s� <br /> CONTR.IICENSE# G' I ��") � <br /> V�TIA�.IF'P►.�1�16(�� � � i � , �. , o �=r <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> 1, �,u iT +q���l..� _Electric _Gas_Other ( gf C��O fJ� <br /> � <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling unils <br /> Balhlub Forced air systems <br /> Lavatory(�vash basin) _ Gas piping <br /> Shower W ater healer <br /> Kitchen sink R disposal _ Gas firep�ace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryer <br /> Waler heater Ranc�e hood <br /> Sink(service/badmopletc.) _ Exhaust ian <br /> Backflow preventer _ Heat pump <br /> Urinal Cnit heater <br /> Drinking Founlain _ Boiler <br /> Floor drain Re(rigeralion <br /> Grease Uap _ Woodstove <br /> Roof drains _ Other <br /> Olher "� S �(KL&,2 <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby r,erili(y Ihal I have read and examined this application and know the same to be lrue and correct. All provisions of laws and <br /> ordinaces 9oveming this rype of work will b�complied�viUi whelher specified herein or not.The granling of a permit does not presume <br /> to give aulhor' to w4lale or can I Uie provision o(any other state or local law regulating construction or the performance of <br /> construclion. 1 t I a�i authorize by he owner of this property lo perform lhe work for which applicalion is made and I comply with the <br /> Slale Contra lo s La 8.2 R a� 296.200 WAC. <br /> 'i �/ n, b•-ZQ- cv6 <br /> Signature of Owner/Conlractor/Auth ed Ac�ent Date � L <br />