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P�RMIT APPLICATI(�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 99201 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PAFcCEL 1�AX I.D.# PERMIT# <br /> 6oa - �/r�,,�.�e-.�.� (,�c 5 �70 �o �000U li bw ��� (�'7- D/Z, — <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. //� o��o o-�u ✓c�,(a,..�. fsdkl� <br /> OWNER ADDRESS CITYIZIP PHONc <br /> GJa�i.c. :�<~ik.sv,-. 6uul - ✓etic.Cc...._ wc�y s�it/ -- <br /> TENANT NAME CONTACT FOR PERMIT � FFICNF <br /> �/ I a�G 9yz- �s4 1 <br /> l!��7� E�MAIL <br /> � CONTRACTOR ,�GS / �`� ADORESS ITY/ZI—P--PH NE <br /> M� <br /> CONTR.UCEfJSE# UUG ' ✓�r�^5�. S1o�C eL ,�<<•, ]r.� �V� 1���� <br /> yy,��siFv_� �- 9� lCM � � � <br /> USE O�UILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> S � Eleclric Gas Olher <br /> WORK DESCRIPTION <br /> - �3., .�a �1�,,,,; O��� <br /> . ----� <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FIkTURE OR ITEM NO. NPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handling units <br /> Balhlub _ Forced air syslems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower _ \Nater he2ler <br /> Kilchen sink 8 disposal _ Gas L.�place <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> Water healer _ Range hood <br /> Sink(servicelbadmop/etc.) _ Exhaust fan <br /> Backflow prevenler _ Heat pump <br /> Urinal Unit healcr <br /> Drinking Founlain _ Boiler <br /> Floor drain Refric�eralion <br /> Grease trap _ Woodstove <br /> Roo(drains _ Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y ihal I have read and examined lhis applicalion and know Ihe same lo be true and correcL All provisions of laws and <br /> ordinaces governing ihis rype of work will be complied wilh whether specified herein or noL The granting of a permit does nol presume <br /> to give authority to violale or cancel ihe provision of any olher stale or local law regulating conslruction or the performance of <br /> conslruclion.That I am authorized by lhe owner of lhis property lo periorm the work(or which application is made and I comply with tho <br /> Slate Contractors Law 18.27 RCW and 296.200 WAC. <br /> �%j �r� � �� i�/zw� <br /> Signature o(Owns/ConlractodAulhonzed Agent —�- � Dale �/7j <br />