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� PERMIT APPLICATION <br /> CITY OF �VE:RETT PERMIT SERVICCS <br /> 3200 CEDAFi STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS P.RE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS ,f C�/� PARCEL TAX I.D.# PERMIT# <br /> /9T�A�� S A-100 SF; c�C„c � — 6 ��� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. ` <br /> OWNER ADDRESS CIN21P PHONE <br /> rlA/L,cl,� .SQuA�CE J�•s��/S� <br /> i�vv,�src�.s P.O. �BG�C' /��" y829� �/z;33y So�B <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> c� curs �c� wru.ig�°1 u7T�E 20�- 9y9- 9'/ZZ <br /> _a ��aati..vi <br /> CONTRACTOR ADDRESS CIN21P PHONE <br /> CONTR.Lr�.v��vT yo20 /9Z,�,'°ST_ s.�, z�-9��9��zz <br /> �y,��,��q� _ <br /> USE OF BUILDING HEAT SOURCE I CQyTRACT PRICE OF WORK <br /> B u.S�� C _ � ,_ ��/� _A <br /> " � � �i Electric Gas Other � <br /> / <br /> WORK DESCRIPTION LG�.Gr S/7 u,�/ � D�NO�f/-LO�/��CJ� J,!/ G(. ,�N�- SO�'� <br /> DA�r1��/•t,Y �+'i�.000sFS. E2�cT �.�JT�iQ.�ie �d-to�ID!l�/�•��7Tio.v <br /> G✓ACCs. I•t�sTRGL 2 EjrH�iifT`B� ��Js�'f}GL �,�s�u..�r�o,v �,4�u.E T,f <br /> c�'a �?� c�C.�,v,c � .�u ,0 �F�i.cY �°u,��fi fS. <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FIXTURE OR ITEM NO. NPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lava:ory(wash basin) Gas piping <br /> Shower Water heater <br /> � Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas renge <br /> Gethes washer Clothes dryer <br /> _ LaundryVay � Rangehood <br /> Sink(servicelbarlmop/etc.) � Exhaustfan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease hap Woodstove �, <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br /> I hereby cerifify ffiat I have read and examined Uiis application 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 auffiority to violate or cancel the provision of any other state or Iocai law regulating construction or ffie pertormance of <br /> construction.That I am authorized by the owner of this property to perfortn the work for which application is made and I comply with the I <br /> State Contractors Law 1827 RCW and 29 200 WAC. <br /> �r/.���'� - s Z�o� <br /> Si naNre of Owner/ContractodAu onzed Agent Date <br /> I�(. <br />