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P�RMIT APPLICATIdN <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 3 �-I6 '-'� 9 <br /> SITE ADDRESS PARCEL TAX I.D.A R�qIT N <br /> �i's'v�/ 7�'/12 < 0�."l Cv�-i y03 -aa�' <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION fl <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> /u�s �+^-»,c�z�i5 �1��.�y �Et� Or. � r E�E�Eii ��z�3 6,23-533-y3�"J <br /> TENANT NAME CONTACT FOR PERMIT (��PHONE ��_y��,jSt77 <br /> iJ <br /> LUlS_(pM3���5 �W/, SCIJM/t� e-Nta� <br /> �ATi�aCTOR �L��y's nlu^��I�1G /35y�7 S.E.;c9'/�L, iyA �F1LF_UUC yzs•6va-6y�� <br /> CONTR.LICENSE p <br /> Ru�YsP103��M�'J 95f�'J5 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �E5�O�-, 1�- ✓ Electric _Gas_Other <br /> �.���.C <br /> WORK DESCRIPTION ��M� �XISTInIG l���l��� �+JAST� � �JI�/��� ��rA�L /J[�LJ <br /> �C IR'1��� .�Inlit W/��[ �r ��VJ�LS r /fi 2L/�l �j]�$. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilel FJC—air handling units <br /> �alhtub Forced air systems <br /> Lavalory pvash basin) Gas piping <br /> Shower Water heater <br /> � Kitchen sink 8 disposal Gas fireplace <br /> _/L Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Waler healer Range hood <br /> Sink(service/bar/mop/elc.) Ezhausl tan <br /> �ackflow prevenlcr Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Reirigeration <br /> Grease Irap Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 9105 <br /> I hereby ceritify thal I have read and examined this application and know the same to be true and correct. A�I provisions of laws and <br /> ordinaces governing this rypo o(work will be complied with whether speci(ied herein or not.The granting of a permit does aol presume <br /> lo give aulhorily to violate or cancel Ihe provision ol any other stale or local law regulaling con=wction or Rie peAormanco ot <br /> conslruction.Thal I am aulhorized by the owner of Ihis property to peAorm the work for which application is made and I comply with the <br /> Slate Conlract r�L 18.27�R+CW d 96.200 WAC. <br /> �//t�.eL�/� 3•��i•�� <br /> Signalurc Owner/Conlreclor/Authonzed Agenl Dale <br />