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.— <br /> PERMIT APPLI�ATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � � p�...Os <br /> SITE ADDRESS PARCEL TAX I.D.p PERMIT A <br /> 128UU 1�of��,ell-CJetett �i.�y ���'�� - I(7 <br /> L[GAI. LOT NO. �LOCK� TRACT Op SU�DIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> �fOU�i�.enc.C. �Z$c7U l3Ut�ll-��etet� {�wu� ��etett WA g$ ZOK <br /> TENANT NAME CONTACT FOR PERMIT PHONE 3(�O !0�{,3 �Ill �j <br /> �rovia�en�e- Re�cl.. 5to�m e.rnai� c e:�ls @ uansly a�o.�o,vi <br /> �-G�O�TR C U��LOU,��� 5i n A DRE T 2P NE 3�0 /a�(3 1{I7 <br /> � �L, �5 /�E H i.JY `�`t Uanf.ow,�� t,)A <br /> CONTR.UCENSEq <br /> URlJCOS� 253 SC. `lSL6S <br /> USE OF BUILDING H[AT SOURCE CQNTRACT PRICE OF WORK <br /> Me���U-� _Electric _Gas_Other � ` O� <br /> WORKDESCRIPTION siq'(1 5 �owble. �uLC ;Il�m��.�e,�1. ��eestw�. ���n' <br /> �J <br /> �� twll � 3Z� o� 5'��i��i.oJe. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ A/C-air handling unils <br /> Bathtub _ Forced air sys�ems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower lNater heater <br /> _ Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clolhes dryer <br /> Water healer Fange hood <br /> Sink(service/badmop/et�.) Exha�wt fan <br /> Backflov+preventer Heat pump <br /> Urinal Unil heater <br /> Drinking Fc,untain Boiler <br /> Floor drain Relrigeralion <br /> Grease trap _ Woodstove <br /> Rool diair.� _ Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> I hereby ceritity that I have read and examined ihis application and know ihe same to be irue and wrrect. All provisions o1 laws and <br /> ordinaces goveming Ihis type ol work will be compiied wi�h whe+her specilied herein oi uot.The aranling of a permit does not presume <br /> �o give authority to violale or cancel the provision o(any olher stale or local law regulating constmction or Ihe p2rtormance of <br /> construction. That I am au�horized by the owner of�his properry lo perform ihe vdork for�vhich application is made and I comply with the <br /> State Contractors Law 18.27 RCW and 296200 WAC. <br /> Signa�ure ot OwnedContracrorlAu;horized Agent � Date <br /> i� <br /> 7 <br />