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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERET7,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 Sf2� l<<�'S j� ��,�_ PARCEL TAX I.U./ PERMIT 1�^ <br /> S13� -��3 � � l�Of- � �- <br /> LEGAL LOT NO. BLOCK TR:"'T <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> �; i�c�� �<i � � �� �j � jG � S-r.� �iu �'Sf 7��: t ���c��iY� �6�1�� YZS-3Z7-o5'zv <br /> 7ENANTNAME I CONTACTFORPERMIT PHONE <br /> CONTRACTOR � �I / �i,� ��,.ct��N'`i ADDRESS!�'1_G -y'``` �;'!', CITY2IP PHONE <br /> � lcJ fTF_ r2�u ��.tiFt <br /> � .�z1;-�j4 -S `/y,c <br /> CONtR.LICENSE fl � LL J�� �� �y7 L ! -? <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> h�.���.�- _Electric �Gas_Other {� /S`C G' �C L� <br /> WORK DESCRIPTION C Ic 1"la� t�.4)l�:-� � �-o•n��r�-� �-c• � c:..�.1 Z- ��t� `L'- �'J' �"� <br /> ��u j�\ :�` � <br /> PLUMBING RIECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> Bathtub Forced air syslems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower W e!er healer <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> t� Clothes washer Cbthes dryer <br /> Waler healer Range hood <br /> f Sink(service/bar/mop/etc.) _ Exhausl tan <br /> Backflow prevenler _ Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roo(drains � �� _ Other <br /> '� Other l�.:�• <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> I hereby ceriti(y that I have read and examined this application and know the same tu be true ar,d correct. All provisions ot laws and <br /> ordinaces governing this type of work will be compiied with whelher specified herein or not.�i he granling ot a permit does not presume <br /> to give authoriry to viol2te or cancel the provision of any olher st2le or loca!law regulating wnsWction or the pedortnance of <br /> conslructior�.Thal I am authorized by the owner of this properly to pertorm the work forwhich appiication is made and I comply with lhe <br /> Stale Co raclors Law 18.27 RCW and 296200 WAC. <br /> � <br /> '� C��.('//. ���._.�_ � 3 vro <br /> Signature of OwnedCoNracrorlAuthonze�Agent Dale <br />