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—� <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERViCES <br /> 3200 CEL�AR STREET, EVERETT, WA 98201 6 -13_07 <br /> 425-257-8810— FAX 425-25' 9857 —w�nrov.ever�ttwa.org <br /> APPLICATIONS ARE ACCEPTEO FROM 6 AM TO 4 PM SEr/-1 D`J'O�O O <br /> SITE enDRESS � PARCEL TAX I.D.f1 PER IT# <br /> -7J � Q63 4�00�00�/DO � ��o�. � .LL <br /> , � Ql��G�J1� �y4a2 C�o <br /> LEGAL LOTNO. BLOCK TRACT /� /� <br /> oesc. .6r G�-+.3-�6�qf a=�2sT 'qn �CX� �OT�— l- �a ��Ru�/ �•Oc.r" <br /> OWNER n ADDRESS CITYI21Py�.���PHONE� <br /> C�Uui2T.uEy l'OtJ2T �[e i�Go� �H�2r� �eS�- /+"1ir�.Ao,:�v [va ¢2s •3s�-e�8� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> I ��+A�fcF,s /t'�o2GAN �/20`- 353-aBSg <br /> ICONTRhCTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# <br /> I <br /> IUSE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORk <br /> N � <br /> 5„���t YAnr�ty ���NF�omE _Electric �Gas_Other /L� ao D <br /> WORKDESCRIPTION �+d�.�reG�f /�! ��NG�E �R�initY Towl���r�6S 1 <br /> l�s� c, -7oumhausG t�Jwr, - 7y/� <br /> 7 �7(q 7 <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilet C� A/C-air handling units <br /> 1 6alhtub � Forced air systems <br /> � Lavalory(wash basin) �� 7� Gas piping <br /> Shower � Water healer <br /> _� Kitchen sink&disposal ,� Gas fireplace <br /> / Dishwasher �_, Gas range <br /> � Clothes washer / Clothes dryer <br /> _ Laundry tray _L Range hood <br /> Sink(service/harhnop/etc.) g�C Exhaus�fan <br /> Backllow prevenler Heat pump <br /> Urinal Unit heater <br /> Drinking Pountain Boiler <br /> Floor drain Refrigeration <br /> Grease trep Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> II hereby cerilify that t have read and examined ihis app�ication and know the same lo be trie and corred. All provisions of taws and <br /> ordinaces goveming ihis type of work will be complied with whether specified herein or noL The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construclion or the pe�formance of <br /> consiruction.That I am aNhorized by the owner of this property to periorm the work for which application is made and I comply with the <br /> State Contractors Law 1827 RCW and 296200 WAC. <br /> �+�t, �� �� Z3 kPiZ o^, <br /> SignaWre o(OwnedCont or/Authorized Agent Dale <br /> \I'� <br />