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rERMIT APPLICAI �ON <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 6 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> ys�G srb- D�, s�, 3 /z vo s .�oo �Co � �a -l � <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. �S �,�� ' <br /> OWNER � ADDRESS CITY2IP PHONE <br /> �¢G J° < �n.�.c'Lcc /�//.,� yio ���, �2�� 3�a-��i-�6o� <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> � ,5.�,�, �-,�..-.-, ��u yzp -�y.�3 <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> /�''�D r� �":.'C�LL C <br /> CON R.LICENSE# <br /> ��� F, /rCL�lc a /Z �� /��D�-xy�� ��� � r'f,Sv'C 3�v��/- '�Gu�/ <br /> USE OF BUILDING � HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��, -�,�,�� 2� I _ElecMc �Gas_Other I / � UO O <br /> WORKDE CRIPTION ��4JV/,�ING �J'/QOG1�Up R�C�-- <br /> �/�'tiv /��''�y / _ _ 3G—��— G,O�UGiQ£T� SL/�,(j�W /.t�SNL/4Tiaif/ <br /> /— Lc'»'Y��� � <br /> PLUMBING MECHANIGAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR iTEM <br /> oilet A/C—air handling units <br /> thtub d-air systems <br /> _ vatory (wash basin) piping <br /> Shower heater <br /> � Kitchen sink& disposal replace <br /> asher range <br /> es washer es dryer <br /> _ Laundry tray ge hood <br /> Sink(service/badmop/etc.) aust fan <br /> ackilow preventer Heat pump <br /> I _ Urinal _ Unit heater <br /> Drinking Fountain Boiler <br /> � Floor drain Refrigeration <br /> i _ Grease trep _ Woodstove <br /> � Roof drains Other <br /> Other <br /> � CITY OF EVERETf LOCAL SALES SAX CODE IS 3105 <br /> II hereby ceritify that I have read and examined this 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 whelher specified herein or not.The granting of a permit does not presume <br /> , to give authonty to violate or cancel the provision of any other state or local law regulating construction or the performanr,e of <br /> i construction. That I am authorized by the owner of this property lo perform the work for which application is made and I comply with the <br /> State Contr cpors Law,1827 RCW-gnd 296.200 WAC. <br /> 1i/ �/;j��,., � <br /> % �'/�/l Gi '" � � i?.S—OS <br /> Signature of OwnerlContractor/Authonzed Agent Date <br /> I <br />