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�-- <br /> � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � ���.�7 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ��/"� O`J"��� <br /> SITE onDRESS � PARCEL TAl(I.D.# PER IT# _ <br /> �,JS:� Cl,fiY1 G�iJ 0a3 v�ooaoo�ioo `20� �yaz oo � - � <br /> LECAL LOTNO. rBLOCK A TRACT �n <br /> DESC. (pl G3 v3--�69qf �-Y'25T- '7D0 7-�0••�7A�VE,k�N'rA-��-- �� �0" �J;�t- �� <br /> OWNER n ADDRESS CITYIZIP����ZFHONE <br /> �Uuk. T.vEyl'OcJ2T L�C /��n07 �Hi2q �� .St, �/[-c�.Qt�.rWll �f2.Y •35�- 6�5� <br /> TENANT NAIAE CONTACT FOR PERMIT PHONE <br /> �r+A�EcF,s l�'�oQGAN �/�5-3 a3-aBd�B <br /> CONTRACTOR ADDRESS CITYIZIP PHONE <br /> CONTR.LICENSE N <br /> USE OF BUILDING HEAT SOURCF I CONTRACT PRICE OF WORK <br /> SrN��t rAn��Cy %u.7/.�NomE _Electric �Gas_Other //�� aDd <br /> WORKDESCRIPTION eo�5i2GCf ����) ��'�G�-E ��mi�Y !Ott�N �m�'S �j�' �4 <br /> �51 C� 7UWYl �')OI-1� {`��kh'1 — 7�/� � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _� Toilet � A/C-air handling unils <br /> 3 Balhtub � Forced air systems <br /> �_ Lavalory(wash 6asin) 9 ri Gas piping <br /> Shower � Water heater <br /> _� Kitchen sink 8 disposal � Gas fireplace <br /> / Dishwasher � Gas range <br /> _� Clothes washer / Clothes dryer <br /> _ Laundry tray � Range hood <br /> Sink(service/bar/mop/etc.) g_,�_, Exhau�t fan <br /> Backflow preventer Heat pump <br /> Urinal Unil healer <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeration <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 lhis application and know the same to be true and wrrecl. All provisions of laws and <br /> ordinaces yoveming 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 io violale or cancel the provision of any other state or local law regulating consiruction or the peAormance of <br /> conslruction. Thal I ain aulhorized by ihe owner of this property to perform the work for which appiication is made and I compiy with lhe <br /> Stale Contraclors Law 18.27 RCW and 296200 WAC. � <br /> � �� � 73 AP2 07 <br /> � Signature of Owner/Cont or/Authorized Agent Date <br /> � - �(z <br />