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P'�RMIT APPLICATIC�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA98201 �_a3_UY <br /> 425-257-8810- FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �,�o5c�-0 36 <br /> SITE ADDRESS �;j��j PARCEL TAX I.D.# PERMIT# <br /> n �0508 ar <br /> LEGAL LOTNO. BLOCK TRACT <br /> UESC. <br /> OWNER Ll�� .� �„^_,� A�I�yS _ CITY2IP C�Z�p� �-p <br /> i r•�J.y -.'--o�c� 1 �P <br /> �� /'� • �-r�"� �YJoR'E�T� � � Z�"?'o tY�(�Gro Loi� <br /> TENANT NAME CONTACT FOR PER T PHONE <br /> �A6�'1�_ �5 �ru`l�4'L <br /> CONTRACTOR ^ �'�j(y.�DDRESS`O Q �,y CITYlZIP PHONE �'� 2 <br /> a�c r� � ,^ <br /> ��'F� �.�(� c�CU�"kC���sl'� �—�l�7 <br /> CONTR.LICENSE p ' � ��1 „ �� " ` p � ��� _ _ <br /> V`Wx-.P" -taYJwjG7 <br /> USE OF[iUILDING HEAT SOURCE CONTRf.CT PRICE OF WORK <br /> �y�l� ��� '�'+ �� _C-lectric __Gas_Other t�2E� ��� <br /> WORK DESCRIPTION �P��'�� � ,� <br /> q F��ka� � v�e�l�,rre� 6e �r�J. <br /> � s���� �d��r g���� t� a�-�� <br /> PLU BING ME�HANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> f3alhlub Forced air syslems <br /> Lavalory(wash basin) _ Ga5����n� <br /> Shower Water healer <br /> Kitchen sink&disposal Gas fireplace <br /> �ishwasher Gas ranc�e <br /> Clolhes washer Cblhes Arycr <br /> Laundry tray _ Ranyc hood <br /> Sink(serviceNar/mop/etc.) Exhaust fan <br /> Backllow prevenler _ Heal pump <br /> Urinai _ Unil heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeralion <br /> Grease trap _ VVoodslove <br /> Roo(drains Olher <br /> Olhcr <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify thal I have read and examined this application and kno�•i the same to be true and wrrecL All provisions of laws and <br /> ordinaces goveming Ihis lype o(work will be complied wilh�vhelher speci(ied hem'n or not.The granling of a permil does nol presume <br /> to give aulhoriry to violale or cancel lhe provision o(any cther slate or lucal law regulaling conslniction or lhe performance of <br /> conslruclion.That I am authonzed by the owner of lhis property to pedorm Ihe work for which applicalion is made and i comply wilh lhe <br /> Slato Co raclors Law 18.27 RCW and 296.200 WAC. <br /> � D <br /> Signature o( wne Conlractor/A lhorized Agent Date <br />