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ERMIT APPLICATION -� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 6 �r3 -07 <br /> 425-257-8810- FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AP�1 TO 4 PM SE/"/`� O.5�D�O O <br /> SITE onDRESS PARCE�TAX I.D.p PEjRh�11T#�,f <br /> /.�-:i��l{/j�G�1J �a3 4-00000�/00 , G�o���yoz cn ( , �/tl - �� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. (oi L21n3 � 79f� �..F-�4.-SrA� ��oN--ra-�-�rE�rv�r+-�,c�, o( b( ��- �ou v�/tI�EL���� <br /> OWNER ADDRESS CITYIZIP PHONE <br /> ����Z" <br /> C�Uu Q. T�vEy �o�2r �LC /4G o� •i y�a n �2 S, � /nii..c�eE�ic Gv4 ¢zs •3S 9- 6�'8� <br /> TENaNT NAME CONTACT FOR PERMIT PHONE <br /> ��A,�t� /�'�DQGAN �/sS-353-e26dg <br /> �, CONTRACTOR ADDRESS CITYIZIP PNONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> i <br /> S/NGLt �n��cy �J�NNomE _Eledric �Gas_Other �L� ppd I <br /> WORKDESCRIPTION �d�.�ieLGf �S S�,uG�E FA�Mi�Y ��/� �^'6S ��,yy�- 5 <br /> �s, c, 1"o�.�mha+�se 1�1��-, - TYf�' — <br /> II PLUMBING MECHANICAL <br /> I NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF PIXTURE OR ITEM <br /> � Toilet K� A/C-air handling units <br /> 3 Bathtub L Forced air sys;ems <br /> �_ Lavatory(wash basin) � 7� Gas piping <br /> Shower _L Water heater <br /> � Kilchen sink 8 disposal _� Gas fireplace <br /> � / Dishwasher �_ Gas range <br /> _� Clolhes viasher / Clothes dryer <br /> _ Laundry iray �_ Range hood <br /> Sink (service/bar/mop/etc.) g� Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeretion <br /> Grease irap Woodstove <br /> Roo(drains Olher <br /> Other <br /> CIIY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I liereby ceritify tha� I have read and examined this application and know lhe same to be true and cortect. All provisions of laws and <br /> I ordinaces governing this type of work will be complied with whether specified herein or not.The grenting ot a permit does not presume <br /> to give authority to violate or cancel the provi�ion of any other slate or local law regulating construction or the performance of <br /> construction. Thal I am authorized by the owner of ihis property to perform the work for which application is made and I comply with the <br /> � Stale Conlraclors Law 16.27 RCW and 296.200 WAC. <br /> `,v� �' C�`�ti•� Z3 kP�2 07 <br /> SignaWre of OwnedContr�.or/Aulhorized Agent Dale `' <br /> YZ <br /> � _- <br />