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FcRMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERV�CES <br /> 3200 CEDAR STREET, EVERETT, WA 982U1 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS 98�3 PARCEL TAX I.D.# PERMIT# <br /> ����� z��r�. w �:wA o066 P�'�oo009 00 �.a��. o�-i <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> oes�:. 9 No. z ooa —�oo �/rr�� s-¢av.:e,..� �sfi•-�- <br /> OIN EN R � ADDRESS CITYIZIP PHONE /�^a�u� <br /> C' G�-rn.� Yau�-. s�i 7 �3�f� � cv�tt. 9 8ze�3 y-�s- <br /> TENANT NAME CONiP.�T FOR PERMIT Q?�7-SI—jS�� PHONE ��^O s��[H 1 <br /> � S � <br /> ('�='yX.2` �it''`�" e Ma C T+Na*��-6 �' '�q� � <br /> CONTRACTOR n � „nG�I� D�€S`S CIT�'��� E � L�� d <br /> i�_ �x �?0.13 0�c /5�66 St,�.Q�la-.. �2S_2_3 <br /> CONTR.LICENSE# S � av � � 933 �� 9s�� <br /> USE OF BUILDING — HEAT SOURCE � CUNTRACT PRICE OF WORK <br /> Eleclric _Gas__Olher ��i. �20 .ODV <br /> WORK DES�RIPTION <br /> [b.i cn.�yu_rfn�•• ea Y�-�� wa�GC favf� .-,.-y-,Ye nY►/ls�y-�`o : /�o.��`'t rG wQ.r/ - 6 f'f- <br /> -.Q.,��. : G� ff f 7 f1-��E.f.s�h-� <br /> PLUNf81NG MECHANICAL <br /> NO. TYPE OF FIXTURE Ok!TEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A�'C -air handling uni�s <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink R disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Cblhes watiher Clothes dryer <br /> Waler hea: r Range hood <br /> Sink(service/badmop/etc.) _ Exhausl tan <br /> BackOow preventer _ Heat pump <br /> Urinal Unit healer <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeration <br /> Grease!rap _ Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY Or EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I I hereby ceritify lhat I havt read and examined this applicalion and know the same to be lrue and correcl All provisions of laws and <br /> e,rdinaces governing lhis type of work will be complied wilh whelher specified herein or not The granting of a permit does not presume <br /> to give au;hnrily lo violale oi cancel the provision of any other state or local law regulaling construclion or the performance of <br /> construciiva. Thai! am authorized by thP owner o(lhis properiy to perform the work for which application is made and I comply with lhe <br /> Stale Contraclors Law io.2? RCW and 296.2C0 WAC. <br /> ���� Sr���2 ao9 <br /> Signalure oi OwnedContra r/Aulhorized Agent �ate � <br /> � L <br />