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P�RMIT APPLICATIOrI <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 TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# P R IT 1f_ <br /> L(y U ��ew Gv'e5-�" �E GO� Z b �� �C <br /> LEGA L TNO. BLOCK TRACT � <br /> �esc. � �(A}- �i oo"L -02 S�eaVi w �� <br /> OWNER I ADDRESS CITY2IP PHONE <br /> �G�+f � � �1�' �L�fQ-5!� NGW S MGi.✓i Z�( -�a V��w G✓�.5�' �l�C1/�- 9��'l3 <br /> —� CONTACT FO PERMII rn�nc <br /> TENANTNAME <br /> '�a.u( Vun �lycl� �lZs- �37�-9�//� <br /> CONTRACTOR ADDRES3 CITYlZIP PHONE <br /> UF!-NSLYct�. /.}Ssoc.i,�.�s , �,vc. ��. $o,C i3o� G �✓2,u.Et- �f8�� <br /> CONTR.LICENSE N � (�ZS—� �7 U._ /:��Z. <br /> LANSL�� d� 2.� DU �� <br /> USE OF BUILDING HEAT SOl1RCF CONTRACT PRICE OF WORK <br /> S F R�s��{^�� I _Eleclric �Gas_Other �� D d O _ <br /> WORK DESCRIPTION � � Q <br /> Re���.-z_ k, �cG,,Q., u��-�s, ne..,,. lo�r .^.i <br /> � G�us flti�cj-��� �.e lo rG,F-e- �Gi.n� �.ovc�. ' w , l, <br /> l�'�� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet __ aC—air handling units <br /> 6athtub Forced air systems <br /> Lavalory(wash basin) _L Gas piping <br /> Shower _ Waterheater <br /> � Kitchen sink 8 disposal Gas fireplace <br /> � Dishwasher Z Gasrange <br /> Clothes washer Clothes dryer <br /> Water healer � Range hood <br /> Sink(service/bar/mop/etc.) _ Exhaust tan <br /> Backflow preventcr _ Heat pump <br /> Urinal _ Unil healor <br /> Drinkiny Fountain _ Boiler <br /> Floor drain _ Refngeralion <br /> Grease trap _ Woodslove <br /> Roof drains _ Other <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TFJ(CODE IS J705 <br /> I hereby cerilify that I have read and examined this applicalion and know the same to be true and correcL All provisions of laws and <br /> ordinaces gorerning Ihis lype ol work will be complied wifh whelher specified herein or noL Tho granling o(a permit does nol presume <br /> lo give aulhonly lo�.iolate or cancel ihe pr ision oi any other state or local law regulaling construction or Ihe performance of <br /> construclion.That I am aulhoriz9dby t owner of ihis property lo periorm the work for which application is made and i comply with th� <br /> Slale Conlrector�aw 18.27,RCW d 296.200 WAC. <br /> �%� � � _ s- z �_oG <br /> Sigrr ure o(Owner oNraclodAulhonzed Agent Dale <br />