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P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-267-8810- FAX 425-257-8857-wvw:�.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �a „17_Q9 <br /> SITE ADDRESS ���c�� PARCEL TAX I.D.N PERMIT# <br /> { C1G� ✓ � 2'F1�4�ZGO ZU�3C� Q / . 7 <br /> LEGAL LOT NO. �� 06Kv� TRACT OR SUBDIVISION M <br /> DESC. 2 uSIhGSS ZOOS09ZSSS�F� <br /> OWNER ADDRESS CITYIZIP PHC'�E <br /> ,_/ /'�L� VJel.c�G�M�.7��LL 1��� �`.K ZUl Z S�'/1ae�alr�Lc� GJR— Q�lo� <br /> TENANTNAM//E1 CONTACTFORPERMIT PMONE/��j� 3I1���s� <br /> CONTf27C/�Q/M4 •YiJG- �(s�� l/��dr�C E-MAIL � U� V� !C. G' � <br /> ,� <br /> CJllyrr�/�rc- �rtuo,/Ca+�,t,�s; �.LL G,.� 3�1—a�s/ <br /> CONTR.LICENSE N L�l/��� w� <br /> ��r,.�.�t�tr-'vG 97� �Z. 372G t—'y�cAclw�y S�,�t 3A2 q_��o � <br /> USE OF RUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> e1 �• _Eleciric ,�Gas_Other (S 6c� <br /> (=t _A � ��,��p <br /> WORKDESCRIPTION a��/d (�(/�IY/N� �/s/( iy� G1�(S�`/�f a,�f'�� ^�"7' ��� / <br /> �� ��'�r�. tlG'Iv-� �/�s'. ir�.-.�s - <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTUR[OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toi�el AIC-air handling unils <br /> 6athlub Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Water hea�er <br /> Kilchen sink&disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> C�olhes washer Clothes dryer <br /> Waler healer Range hood <br /> Sink(serviceNarhnopletc.) _ Ezhaust fan <br /> [3ackflow prevenler Neat pump <br /> Urinal Unil heater <br /> Dnnking Founlain _ Doiler <br /> f=loor drain Retrigeration <br /> Grease irap Woods�ove <br /> Rool drains Other <br /> Olhei <br /> CITY OF EVERETT IOCAL SALES TAX CODE IS 3105 <br /> I hereby certify�hat I have read and examined Ihis applicalion and know tiie same to be irue and cortect All provisions of laws and <br /> ordinances goveming this�ype of work will be complied wilh••�hether specified herein or not.The granting of a permi�does not presume <br /> to give aulhoriry lo viola�e or c2ncel Ihe provision of any o�her sta�e or�ocal law regulating wns�ruction or Ihe performance of <br /> � conslruc�ion.That I 2m aulhorized by the avner of Ihis property to pertorm ihe work for which application is made and I comply with Ihe <br /> Stale Co rs Law 18.2ZHC and 29620 t C. <br /> L � <br /> � <br /> Si i O� ned�onlractor ed Agenl Gate � <br /> Ci <br />