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. <br /> --� ' .. <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � `�3� <br /> 425-257-8810- FAX 425-257-8857 -www.everettwa.org 7 <br /> APPLIC/�TIONS ARE ACCEPTED FROM 6 AM TO 4 PM SE/�/-/ �.�7"��4� <br /> SITE enDRESS � PARCEL TAX I.D.# PER IT � <br /> �.� � a{/}�(.�JtJ Q63 4�00000�.,/ov G�o� �yaz cr� ,� <br /> LEGAL LOTNO. rBLOCK 7RACT I�,� '�� LD G /� uV � /� <br /> DESC. 61-G-3-trS-a�9T-/- 1LC�-23L��� ��T"�}'F�l; 7 / - C.: h�P.u� (� T� <br /> OWNER ADDRESS CINIZIP PHONE ' <br /> C'1���Z <br /> C�Uu12TtiEy �o�ar ��C i�Go� •�H�ar� �QS�, /+1iu.�¢e�ic Lv� �as •3s�-e�8� <br /> TENANT NAME CONTAt:T FOR PERMIT PHONE <br /> �nA�cEs Morcq,u y�S-3 s3-,2BaB <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE @ <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � <br /> s�u��� �p�i�y /�«7NHomE __Electric � Gas_Other �L� po d <br /> WORKDESCRIPTION Cd/D.SreLGf /S �i,���E /-�'M/LY TpwN ��6$ ��Z(�- O <br /> �s, c� -Towr, hous� 1�J��-, - 7Y�. � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _� Toilet � A/C-air handling units <br /> 3 Bathtub _L forced air systems <br /> �_ Lavalory(wash basin) �] 7� Gas piping <br /> Shower � Water heater <br /> _� Kilchen sink&disposal _L Gas frepiace <br /> / Dishwasher � Gas range <br /> _� Clothes washer / Clothes dryer <br /> _ Laundry tray � Range hood <br /> Sink(service/hadmop/elc.) g� Exhaust fan <br /> Backflow preventer Henl pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> i <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify thai I have read and examined lhis applicalion and know the same to be true and coRect. All provisions of laws and <br /> ordinaces goveming this 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 violale or cancel lhe provision of any o�her state or local law requlating wnsiruction or lhe peAormance of <br /> constructioa That I am authorized 6y the owner of this property to perform ihe work for which application is made and I comply with Ihe <br /> State Contraclors Law 18.27 RCW and 296.200 WAC. <br /> �'lt� s� � � ,,P,Z o� <br /> SignaWre of OwnedConlr odAulhorized Agent Date <br /> ��Z <br /> � <br />