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—'� � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, :.VERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM cj ,.� �.� (p <br /> SITE ADDRESS � PARCEL TAX I.D.N PE MIT�! <br /> liyz�� 2.3�" D� SE ���E��00000�cob _ �G � <br /> LEGAL LOTNQ. BLOCK TRACT <br /> DESC. v, � <br /> OWNER , l ADDRESS � , CITY2IP PNONE IyZS�37� Z�4y <br /> grtc�h � 1'-� ��� Sc�rnc r� II`{'� 23'" O;i�< � tvc��l`, S�Zoy <br /> TENANT NAME CONTA�T FOR PERMIT PHONE <br /> �irlMn So�v4.rS <?-��;� �il�i -71� �3 <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.UCENSE# ����,r���.i'�.i� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��� �-, r� i (�y�n��v�, �� . _Elednc �Gas_OtYar <br /> WORK DESCRIPTION • <br /> `)y�1 c11. .(,� (a-<<1�,� �"1 C�� � 1"C...v�-��c�.0 ` <br /> � <br /> r <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> f Toilet A!C—air handling units <br /> �_ Bathtub _ Forced air systems <br /> 2_ Lavatory(wash basin) _ Gas piping <br /> � Shower _ Water heater <br /> Kitche,i sink&disposal Gas fireplace <br /> Disbwasher Gas range <br /> � Clolhes washer � Clothes dryer <br /> Laundry tray _ Range hood <br /> Sink(servicelbar/mop/etc.) Exhausl fan <br /> BackFlowpreventer _ Healpump <br /> Unnal Unil heater <br /> Dnnking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease lrap Woodstove <br /> Roo�drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and cortect. All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whether specifled herein or nol.The granting of a pertnit does nol presume <br /> to give auth violate or cancel the provision of any other state or local law regulating canstrudion or the perfortnance of <br /> const io Tha I am authoiized by lhe owner o(this property lo perform the woric for which application is made and I comply with lhe <br /> State on tor4 Law 1827 RCW and 296.200 WAC. <br /> �1�—_ � l z�(��: <br /> Sign ture OwnedContractodAuthonzedAgent Date� �/7 <br />