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P��:RIV�IT APPLICATII,N <br /> C�TY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.evereriwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PEi2M # <br /> 1413 23 rd ST � �201 oot�,a'P I 4� 1017 o I =2�v <br /> LEGA LOT NO.�7 ' �t BLOCK TRACT OR SUBDIVISION# <br /> DESC. � OF 14�20 'Ta� O'O� ��ER.L�Tr P�T <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> 4� A�76 <br /> Su E �cv�.cb- � I �F ►3 i 2i'"' sr. �T i 9�1 �s��. <br /> TENANT NAME � CONTACT FOR PERMIT PHONE �jS'i'�j��475� <br /> � �'�c�a+�v�— I r ���' 1 "�S�W E-MAIL 4(�NQ S��d�ef4lw�. OM <br /> �i.(5�2.fuf 6rLtsEN� c..�11� �'n-¢p��,a�'� (.r�� �L-I�Gy 4K' �$'�0 3 <br /> CONTR.LICErAse a <br /> (�03 ��r,�•d �l 9�6-� / -zz - /�- <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �� ��� �lectric _Gas_Other ,�Q��v <br /> WORK DESCRIPTION <br /> (Z.�(,/�� 1{£1�A1�N)f s' CO C.UM NS �7� AAJD ¢A1 U �163 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet H/C—air handling units <br /> Bathtuh Farced air systems <br /> Lavatory (wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink (servicelbar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiier <br /> Floor drain Refrigerafion <br /> Grease irap WooGstove <br /> Roof drains Other <br /> Other <br /> CITY OP EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinances governing this type of work will be complied with whether specified herein or not.Tha granting of a pertnit does not presume <br /> to give authority to violate or cancel the provision of any other state or loca!law regulating consiruction or ihe perfortnance o( <br /> construction.That I am authorized by the owner of this property to pertorm ihe work for which application is made and I comuly with the <br /> State Contr_�18. 7 RCW and 296.200 WAC. <br /> � Mlu-, ►7 2o/d <br /> Signature of OwneNCon ractor/ uthoiized Ag nt � Date t <br /> i / � <br /> L _ _ <br />