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P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVEF.ETT,WA 98201 <br /> 425-257-8810- FAX 425-257-8857 -www.everettwa.org <br /> APPLICATlONS ARE ACCEPTED FROM 8 AM TO 4 PM f U� '�O9-/ � <br /> SITE ADDRESS PARCEL TAX I.D.X PERMIT M �/ <br /> � 36(� (tlETi�toR-� C��l 39/ — `�90 -030 - cs o r� 07�/� /`t <br /> LEGA LOT N0. BLOCK TRACT OR SUBDMSION M <br /> DESC. <br /> OWNER ADDRES��G� y�.ry+ �L, CITYIZI?Z�o PHONE <br /> �T� y1s238 S3-3e <br /> /�t iG14-gEL 2rZ2wra�A.(3.i4 k-'E�._.iA$tE /�,��r. l-fA-+�y5u�1(2 WR- <br /> fENANT NAME CONTACT FOR PERMIT PMONE <br /> /I%f.f,eE �i�z«a-o '�l�5��3&•S�3o <br /> E�MAIL <br /> Fc,s�i��E Lfl�srr. 7307 °�6�P� .tiJ,E �.tarw�Sv,Y�e vzs-z3fr•s�3s <br /> CONTR.LICEN3E R <br /> cva- y�� <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> _E�ectric � Gas_Other <br /> WORK DESCRIPTION <br /> Tn � " f�L� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toiiet PJC—air handling units <br /> Bathtub Forced air syslems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> Water heater Range hood <br /> Sink(servicelbar/mopletc.) Exhaust(an <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Founlaln Boiler <br /> Floor drain Re(rigeration <br /> Grease Irap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceritity Ihat 1 have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governinc�this type o(work will be complied with whelher specified herein or not.The granling of a permit does no!presume <br /> to give aulhorily to violate or cancel the provision o(any other state or local law regulaling construction or the perfortnance oi <br /> construction.That I am aulhorized by the owner o(this property to perform the work for which application is made and I comply with lhe <br /> �Sta�a�+C�o�n,t�rAUors La 18.27 RCW and 29G.200 WAC. <br /> �'�fl�l� ��� -�c+ �/• /5� D 7 <br /> Signature o(OwnedC acrorlAuthonzed Agent Date ( <br /> �2 <br />