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P�RMIT APPLICATIVN ,,1, <br /> CITY OF EVERETT PERMIT SERVICES '� <br /> 3200 CEDAR STREET, EVERETT,WA 9A201 <br /> 425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> Z L,Q� APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � r��'/U � <br /> .LL= <br /> SITE ADDRESS PARCEL TAX I.D.A� PEPMR/ <br /> 3yxx WA„� �'„ GOS� 17ao 600 500 <br /> LEGA LOTNSO,. OO6 S'J10YQ. 0.Grr5 �qi�`� <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> S�I-e�� C�Uw�ix� 3�( (� W�vc �r l=•ierc N' bl.� �jgZ03 `I�S SIw0y4'7 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> S+e,rc.. G��� y�S'- 3yY F�3S9 <br /> CONTRAC'[OR , � ns$OL 3y�y il�a�edr �V�Ye-�' �/�., P�ONE <br /> C.r�.,•���o,rd rr , y�S3yY 8�351 <br /> c�CRiaisr F A � I�y ca v�.s s7y-Oy97 <br /> USE OF BUILD�NG HEAT$OURCE CON'RACT PRICE OF WORK <br /> / <br /> ,`�� , �� � _Electric V Gas_Other <br /> WORK DESCRIPTION /� [1 [� <br /> �V�ST Y vi C�i OYl a,F1-E s ���n ce TU� �fG.W T-CI� 7 (�It1 i '�/ <br /> / <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilet I I� AIC—air handling unils <br /> Bathlubll I� Forcedairsystems <br /> � Lavatory(wash basin)'FW � Gas piping <br /> _J__ Shower� ,_J_ Waterheatorl <br /> 1 Kitchen sink&disposai L Gas fireplace� <br /> A Dishwasher I Gasrange <br /> � Clolhes washen i I Clothes dryer I I <br /> � Water heater �_ Range hood � <br /> � Sink(service/badmop/etc.)�I � Exhausl tan 7f'f� <br /> C Backflow prevenler Heat pump <br /> � Urinal Unit heater <br /> C Drinking Fountain _ Boiier <br /> C Floordrain Ro(rig�ration <br /> C'� Grease lrap _ Woodstove <br /> Z� Roof drains Other <br /> C Other <br /> I <br /> CITY OF EVERETT LOCAL SALES TA7(COUE IS 3105 <br /> I hereby cerilify Ihat I have read and examined this application and know the same lo be true and correct. All provisions of laws and <br /> ordinaces governing lhis type of work will be complied with whether specified herein or noL The granting of a pertnit does nol presume <br /> to give authoriry to vio�ate or cancel Ihe provision of any other state or local law regutating construcUon or lhe pedormance of <br /> construction.Thal I am aulhorized by lhe owner of this properly to perform lhe work(or which applicatlon is made and I comply with the <br /> Stale n actors La v 18. 7 RCW and'296.200 AC. <br /> ��. ,� ��t w �/9/o G <br /> SignaWre of OwnedContrac�or/ Ihonzed Agent Date �/ <br /> Z <br />