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---{ - <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 G _� 3 _ p � <br /> 425-257-8810 FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM SE/"/`1 �.5"U�o <br /> SITE onDRESS ' PARCEL 7AX I.D.p PERMIT# , <br /> " ' ,� _ 70�-4 a <br /> i�� ..Ji Q,f�'1L� �a3 �l-oD000�/00162oa.��4oz er, � <br /> LEGAL LOTNO. BLOCK TRACT <br /> oEs�. � .LoT S- �'our-In��� C.fi' <br /> (�J--�� - r - �DD 7/on-� �� �VG«1•n •� � — <br /> OWNER ADDRESS CITY2IP�����PHONE � <br /> �vu R T,vEy �o u2T L[C /�G O� .y�2 rJ �(. 'S� /r1/c.tF�.Ct� CJl1 �25 •35 7- 6�L <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �NA4cGs Mo�cqN �/2J- 353—s2Ssg <br /> CONTRACTOR ADDRESS CITYIZIP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT?RICE OF WORK <br /> sii✓��t I'R����Y ��`�NNom[ _Electric � Gas_Other �WapD <br /> WORKDESCRIPTION ed�.�rQLGf �� ,��NGLE �R�Mi�Y ��w/���65 �,�}'t�,� ,,� <br /> �s,c� Town hai.�se, 1�l��,-� - 7�� � <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> � Toilet � A!C—air handling units <br /> 1 Bathlub � Forced air systems <br /> _� Lavatory(wash basin) 9 7� Gas piping <br /> Shower � Water heater <br /> _� Kitchen sink 8 disposal � Gas fre�lace <br /> / Dishwasher � Gasrange <br /> _� Clothes�rashcr / Clolhes dryer <br /> _ Laundry tray � Range hood <br /> Sink(servicelbar/mop/etc.) g� Exhaust fan <br /> Backflow preventer Heal pump <br /> Urinal Unit heater <br /> I _ Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS�105 <br /> I hereby ceritify tl�a�1 have read and examined this application and know the same to be irue and wrrect. All provisions of laws and <br /> ordinaces governing this type of work will be complied wilh whether specified herein or not.The granting of a permit does not presume <br /> to give aulhoriry lo violate or cancel the provision of any other state or local law regulating consiruction or lhe performance ot <br /> consiruction. That I am authorized by lhe owner of this property to perform the work for which application is made and I comply wilh lhe <br /> Slate CoNraclors Law 18.27 RCW and 296.200 WAC. <br /> Cj�y_____�� Z3 /FPiL 07 <br /> Signalure of OwnedConl odAuthorized Agent Date <br /> `�. <br />