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'� <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 G -13-0� <br /> 425-257-8810- FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM SE/"f� ��-D�g <br /> SITE e�DRESS ' PARCEL TAX I.D.q PE�IT 8 <br /> �.�� � /,11�1'1!.!'lt/ �a39 µ00000�ioo , 6ao���yoz cn ( _7� � <br /> --� <br /> LEGAL LOTNO. BIOCK TRACT ,p� ,, Jj�j� /\ � <br /> DESC, (ol G3.v3 _7_6.79f _F�-Sr�Qe No�E.IQ+Y+fI-�l�–�' iCVI �V ��.:i' ;� i-trr' / � �— <br /> OWNER ADDRESS CITYIZIP PHONE y{ � <br /> �/���Z– <br /> C�Uuk. Tn�Ey �o�2r �LG /�FGv� •lN�2,� 17QS� /nir.-c�eE�t Cv/1 �2� •359-b�� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> I �aKAQc� /�1o2cA�u ��s`-353-e2B8�g <br /> CONTRACTOR ADORESS CITY121P PHONE <br /> CONTR.LICENSE M <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> � <br /> S,N��� ��,��y /�r.�NalomE _Eleclric _Gas_Other �/o/ ppD <br /> WORKDESCRIPTION e,�.57QG�f /� .�iNGLE FAmicY ipwN�ni65 <br /> ��l�!� /Z <br /> /�s� c, -To�vn hous� 1n%wr - 7Y�. 3 <br /> PLUMBING MECHANICAL <br /> NO. I TYPE QF FIXTURE OR ITEM NJ. TVPE OF FIXTURE OR ITEM <br /> � Toilel � A/C–air handlin� units <br /> 3 Batli�ub � Forced air systems <br /> � Lavatory(wash basin) � 7� Gas piping <br /> Shower ,� Water heater <br /> _� Kilchen sink&disposal �_ Gas fireplace <br /> / Dishwasher � Gas r.nge <br /> � Clothes washer / Clothc;dryer <br /> _ Laundry tray L Range hood <br /> Sink(service/bar/mop/etc.) g,� Exhaust fan <br /> Backflow prevenler Heat pump <br /> Unnal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease Vap Woodstove <br /> Roof drains Other <br /> O�her <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify tha�I have read and examined this application and know the same to be true and correct All provisions of laws and <br /> ordins�es goveming Ihis type of work will be complied wilh whether specified herein or nol The granling of a permit does not presume <br /> to give authority to violale or cancel the provision of any other state or Iocal law regulating construclion or lhe performance of <br /> construction.That I am authorized by Ihe owner of this property to pe�form Ihe work(or which application is made and I comply with lhe <br /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> � S �a.` Z3 AP�2 07 <br /> SignaWre of OwnedConlr .orlAulhor¢ed Agent Date I <br /> \ Z <br />