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P�RMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM T04 PM �j —S� --0� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> . R,u � �-f- � �(�'O l 2. <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE -zS -L�j <br /> Gize� ��tifiCc '-12aa ���ta ,,�� ���- i�- (::c.���nF�F� cJ�- � b �3 <br /> TENANT N ME CONTAC FOR PERMIT PHONE <br /> E•MAIL <br /> NTR CTO ADDRES 1 P <br /> � �"�c-r i�c� CP`i�� �'�' �(S7N -71s� SNc��-ScJ �u��If�c,� `�ZS -308- SZyI <br /> CONTR.LICENSE N /1 N`,��i�� G�SS NG� '�) �2� - <br /> r� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Other � 11� �� <br /> WORK DESCRIPTION <br /> ��-.�+G t rC�,�LCc_t�Cr�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilcl A/C-air handling unils <br /> Balhtub Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower N'ater healcr <br /> Kilchen sink&disposal Gas�ireplace <br /> Dishwashcr Gasrange � <br /> Clothes washer Clothes dryer <br /> Watcr heater Range hood <br /> Sink(serviceNar/mop/elc.) Ezhaust(an <br /> �ack(lo�v preven�er Heat pump <br /> Urinal Unit heater <br /> Drinkin9 Founlain Boiler <br /> Floor drain Refrigeration <br /> Grease lrap Woodslove <br /> Roof drains Other_ _ <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby cerility that I have read and examined this applicalion and know lhe same ro be true and correct. All provisions of Iaws anJ <br /> ordinaces�overning this type o(�vork will be cumplicd with whelher specified herein or nol.The 9ranling of a permit does not presume <br /> lo give authority to violate or cancel ihe provision of any olher slale or local Iaw rec�ulaling construclion or the performance of <br /> conslruclion.Thal� am aulhorized by lhe owner ol this property to peAorm lhe work lor which applicalion is made and I comply wilh the <br /> Slate Contractars l.aN" . CW and 296.200\NAC. <br /> i � <br /> 6= �- u <br /> Signalui�t� wn r7ContraclorlAuthorized Agent Dale <br />