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( t <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-wv �.everettw;: org <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM (�{, /Z - 2 <br /> SITE ADDRESS J � C PARCEL TAX I.D.8 PERMIT X <br /> � �Y / ' 1 Zv��eTfEJ(J}'C �� I � �2 � <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION� <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> {�,r ��o I c� ���r- f�u� �G I� 7y�4 si..�'��1, K�it�� c�� `�'gz�S <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> E�AAAIL <br /> �� '� / � A�DF-2�3`S I� I <br /> � �ro���/4�j�e L/��ict<t-�r.�r� �n.c, ( -r(1 �( r✓r�r�.1f �`-'� n[J�2nl L(ZS-ZSl-�l (��� <br /> CONTR.LICENSE# � ,, p ` I ,1� � � �O/�U�Z �P`��Y <br /> (l��•cca�� v <br /> USE OF BUILDING � HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��� a c�.,.,r C� �/1��S�e- <br /> S[Electric _Gas_Other 5, �pG; <br /> � <br /> WORK DESCRIPTION <br /> ��.L t�o l �t� a� / �'ec�/� s �>�„ef �%��. L� �� <br /> PLUMBING MECHAM��,L <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM � <br /> � Toilet A/C-air handling units <br /> Bathtub _ Forced air systems <br /> �C Lavatory(wash basin) _ Gas piping <br /> � Shower _ Waler heater <br /> � Kitchen sink 8 dicpecaL _ Gas freplace <br /> Dishwasher Gas range <br /> � Clothes washer _ Clolhes dryer <br /> � Water heater _ Range hood <br /> � Sink(servicelbar/mop/etc.) _ Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal Unit heater <br /> _ Drinking Founlain _ Boiler <br /> Floor drain _ Refrigeration <br /> Grease trap _ Woodstove <br /> � Roof drains _ Other rL�a��"'�� ��`S� �'"��� � <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certi(y lhat I have read and examined lhis application and know the samE to be true and correct. All provisions of laws and <br /> ordinances governing this type�f work will be complied with whether specifed herein or not. The granting of a pertnit does not presume <br /> to give authorit to violate or cancel the provision of any other state or local law regulating construclion or the perfortnance of <br /> constr � n. T at I am aut ized by lhe owner of this property to perform the wo?�c fc:which application is made and I comply with the <br /> Sta ont[ac�ors Law 18 7�2CW and 296200 WAC. <br /> ldC�- Jo <br /> gnature f Owner/ ontr ctodAuthorized Agent Date <br />