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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 G _ i3 —b � <br /> 425-257-3810— FAX 425-257-8�.57—www.everettwa.org <br /> APPLICATIONS AftE ACCI:PTED FROM 8 AM TO 4 PM SG/"/-� D`J"�O D <br /> SITE D�DR[SS ' PARCEL TAX I.D.# PE TL� S� <br /> �.,.�j �� Cf,{�}'J(,C� �63 v�00000�/o0 6�0� �4az8m <br /> LEGAL LOT N0. BLOCK TRACT I <br /> oEs�. �, c�._v3 �e�9-� �F2s�-9 7YON�-�u�z��°��� LbT I O— C�� n- r1e�� <br /> OWNER ADDRESS cirraia�ko��_PHONE <br /> �Uu R- T,vEy �o�2r L LC /�FG 07 •/H i2(J 17i� S� /nic.cNEEEic (,�J� �2,Y -35 7-b�� <br /> TENANT NAME CONTACT FOR PEF'MIT PHONE <br /> I �r+A4tEs /1'IoQGA,� �/zo-353-,2BSg <br /> CONTRACTOR ADDRESS CITYIZIP PHONE <br /> CONTR.LICENSE p <br /> USE OF BUILDING I — HEAT SOURCE I CnNTRACT PRICE OF WORK <br /> � <br /> S�N��G �n���y /�u)NNomE Electric �Gas Other �(�/ oOT, <br /> WORKDESCRIPTION Cb�.��eG�f �� ,��NGLE FA�MitV ipwN �"ES I <br /> � /J- <br /> �si c� -I"�u�r, hous� l�l�r, - 7 y`,�. �. <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> ? Toilet C� A/C-air handling units <br /> 3 6atlitub L Forced air syslems <br /> � Lavatory(wash basin) �] 7t Gas piping <br /> Shower � Water heater <br /> � Kitchen sink 8 disposal � Gas fireplace <br /> / Dishwasher I Gas range <br /> � Clothes washer % Clothes dryer <br /> _ Laundry lray � Range hood <br /> Sink(service/bar/mop/etc.) �� Exhaust fan <br /> Backllow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Ooiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> I _ Roof drains _ Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined Ihis applicalion and know lhe same to be lrue and wrtect. All provisions oi laws and <br /> ordinaces governing ihis type of work will be complied with whether specified herein or not.The granling of a permit does not presume <br /> lo give authority lo violale or cancel the provision of any other stale or local law regulaling construction or the pertormance ot <br /> conslruclion.That I am authorized by the owner of this property lo perform the work for which applicalion is made and I comply with ihe <br /> Slate Contractors Law 18.27 RCW and 296.200 WAC. � <br /> �v�, £� C� 23 APrZ o7 <br /> Signature of OwnedContr or/Authorized Agenl Date ^ <br /> ( Yz <br />