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/ <br /> P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVER�Ti, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � �a7—(D <br /> SITE ADDRESS �S�O� .Sl��n1i T �UE PARCEL TAX I.D,p PERMIT N <br /> �v'EKCi i lr/,A �� DOS/ S 53,5 / 7U D ��O C� - I <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. ��G � E •�7 <br /> OWNER ADDRES CITYIZIP PHONE <br /> �'N v,e/'i-f d� l�� �/� �!� �1.�`, ��o� �vmm�-��t E'9r��,-�i- 5��s'�5��/y-�l9 <br /> TENANT NAME OO�CT FOR PERMIT PHONE(�C� 2��,�4.�y <br /> �"�JT � ' I �� E-MAIL �YEI'1 p ,►/�'('I"�'II.II� <br /> �aug�� ,� � z� J <br /> �dD�}1' SiGr1�6E �t-C /�(�/ Su�/�/YSiDE ,�•�MS�I�LE ��5397,5885 <br /> C NTR.LICENSElI <br /> �o nr�����9�a.T�t �ro 9g�7o <br /> USE OF BUILDING HEAT SOURCE CONTRA��RI�E OoF?Wl0^RK <br /> / <br /> io �, 1�C� ' � _Electric _Gas_Other <br /> (.rI1I/ /�,r�� � ��r� <br /> WORKDESCRIPTION � (–�[L ST �I�C •�IG ��-`�-Jr� �� '{' <br /> ,/-}�i i�CH ��) �i.�d S/Ei�c/5 ?� C',f�tJ,eGH 70 uJ� <br /> � 7T 5 :�%/. ' " �"T- �t" / l!/fIG� S,C�ti1 Ta Z � <br /> PLUMBING MECHANICAL ( <br /> NO. TYPE OF FIxTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet _ FVC–air handling units <br /> 6a�hlub _ Forced air syslems <br /> Lavalory (wash basin) _ Gas piping � <br /> Shower _ Waler healer ��� <br /> Kitchen sink 8 disposal _ Gas fireplace ``,�� <br /> DisMvasher _ Gas range <br /> Clothes washer . _ Clo�hes dryer <br /> Wa�er healer _ Range hood <br /> SinY.(service/badmopletc.) . _ Exhaust fan <br /> �ackAow preventer _ Heat pump <br /> Urinal _ Unit healer <br /> _ Drinkinc�Founlain _ Boiler <br /> Floor drain ,_ Reirigeration <br /> Grease Irap _ Woodstove <br /> Roof drains _ Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> I hereby certify that I have read and examined this application and know the same to be lrue and correct. All provisions of laws and <br /> ordinances governing Ihis�ype of work wdl be complied with whether specified herein or nol.The gran�ing of a pertnit does�ot presume <br /> to give authority to violate or cancel the provisior of any olher stale or local law reguiating construclion or Ihe peAormance of <br /> construclion.That I am a�thorized by the owner of this property to periorm ihe work for which application is made and I comply with lhe <br /> State Contraclors Law 18.27 RCW and 296200 WAC. <br /> ,c�..�,-����l.T«-,�,� 7//v�io � <br /> SignaWre ot OwnedConir•�ct /Au�honzed Agenl Date / <br /> a <br />