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f i <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CFDAR STREET, EVERETT, WA 98201 � � �3 _07 <br /> 425-257-8810- FAX 425-257-8857 -wv�rov.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM SC,J'� D`J'U�� <br /> SITE onDRESS � PARCEL TAX I.L.# PER�'4IT--�#� �� <br /> �f. 9 ClG4'1 G!'JtJ oa3 v-00000�ioo `ao� �ynz s ro ��� <br /> LEGAL LOTNO. BLOCK TRACT <br /> oESC. 6i. G2 v3--7�'�9-F -r�-�2�r-AIID- 7io,u ��— �o�;a- �����,.�f cT <br /> OWNER ADDRESS CITYIZIP�����PHONE • <br /> C�U�RT�vEy �o�2r �CC i�Go� .H,a,� t7� S� /ni�.c�,er� Lv� �f2,Y •3S�- b�S� <br /> TENANT NAME CONTACT FOR PERMI7 PHONE <br /> I.NAQLFiS MOQLAN �^5-a 53-e28S8 <br /> CONTRACTOR ADDRESS CITYIZIP PHONE <br /> CONTR.LICENSE 1t <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> s�uc�c Y/t����y �"-�NHomE _Electric �Gas_Other ��� op D <br /> WORKDESCRIPTION C+6�.��QG�r ��! ,�,,���E ��Mi�Y �awN ��i6S -f� <br /> �G�-.�; �l <br /> �s� c� -Towr�house 1��)��n - 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 /> 1 Bathwb � Forced a�r systems <br /> � Lavatory(wash basin) � 7� Gas piping <br /> Shower � Water heater <br /> � Kitchen sink 8 disposal _L Gas fireplace <br /> / Dishwasher _� Gas range <br /> _� Clothes washer / Clothes dryer <br /> _ Laundry Iray � Range hood <br /> Sink(service/bar/mop/etc.) 9� Exhaust fan <br /> BackOow preventer Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeralion <br /> Grease trap Woodslove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify tha� I have read and examined this app'ication and know the same to be true and correct. All provisions of laws and <br /> ordinaces goveming lhis rype of work will be comp�ied�vith whether specified herein or noL The granting of a permit does not presume <br /> to give authoriry lo violate or cancel ihe provision of any olher slate or local law regulaling construction or the performance of <br /> construction.That I am authorized by lhe owner of this property to perform ihe work for which application is made and I comply with the <br /> Slate Contraclors Lavr 1827 RCW and 296.200 WAC. � <br /> �� � l� 23 hP�2 07 <br /> Signature of OwnedConl orlAuthorized Agenl Date <br /> `I L <br />