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r'ERM�T APPLICAI iOfV <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 58201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIQNS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREUIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> / - T �': �E� 3 /Z 90 S 30o S�Co c, ( S '-` � (9 <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. �� �y�� <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> �¢L� ��� ��,�f'/1 c r//.�.xy�o C��, s�sZ3� 3�0-��.-��a� <br /> TENAG T WAME I CON'lACT FOR PERMI7 PHONE <br /> ���.�vz, -�-,., .��u 9'Z 9 —i p,�3 <br /> CONTRACTO�R� f nLL � AD�RESS CITY/ZIP PHONE <br /> �¢G, CJIR/+�C � <br /> CGN R.LICENSE# <br /> �AF/CCL�co /2 �� ��o��xy�� ��� , y��� 3 ��.���- ���v <br /> USE OF BUILDING I — HEAT SOURCF I CONTRACT PRICE OF Y�ORK <br /> 5�,� /�'� ��GJ*„� Electric �Gas Other 9� �O U <br /> ,�-I <br /> WORhDESGRIP710N ��L�I�I,(3/NG �j-.Qo%�.�✓�' RIC�- <br /> ��� �ru� ���z�����o�/ciPFT�' SLi�,CS�u� %vsviwT.oN <br /> � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> — Toilet A/C-air handling units <br /> Bathtub _L-Forced.air_systems <br /> L-avatoryjwash besin) Gas piping <br /> Shower � Waterheater <br /> _�-KiteMemsink�-disposal -t-- Gasii2place <br /> 1_ ishwesher Gas renge <br /> �-ClothQs�asher 1-�—-Glothes dryer <br /> _ Laundry tray -f--Rangehood <br /> Sink(service/badmop/etcJ � -xqeus!-faa <br /> � Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> =f�����A Refrigeratior. <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 I <br /> I hereby ceritify that I have read and examined this applicalion and know the same to be true and correct. All provisions of laws and <br /> � ordinaces governing this type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authorily to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> State ConV rs Law 18.27 RCV 296.200 t^JAC. ' <br /> /.%�"'�fC � '.�S-OS <br /> Signature of OwnedCohtractodAuthorized AgeN Date <br />