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�� PEPMIT APPLICATION <br /> ' CITY OF EVERETT PERMIT SERVICES <br /> I� 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425 257-8810 - FAX 425 257 8857 - www.everettwa ory <br /> I <br /> I APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM �p .-OI �-D� <br /> � SITE ADDRESS PARCEL TAX I.D.R PERMIT k <br /> i o`i 1 L'�''` '�c NF Zg os � 9004 o t Soa ��c1(U UGZ <br /> I LEGAL LOT N0. BLOCK TRACT OH SUBOIVISION p <br /> DESC. ��" <br /> � L __ <br /> OWNER AD�RESS CITVSIP PHONE <br /> �5.�,,� c�.r+T�..� �L� � so � �. Z�'" sr. sr�oa-E��NE tibi33 aoo.s3a.z�� <br /> TENANT NAME CONTACT FOR PERMIT PHONE �y , S 3� , -y�.�� <br /> I�1M QoD4Ea'+-S E�MAIL 3�o0�.E�feSLAGO�P• <br /> —P�bRE�— GOM <br /> $G�A Go�-?or�A�-t�a.J � Sb1 rJ. 2aoTN- ST. SH���NE �If i33 zo(�, s3�.21� I <br /> CON7R.LICENSEp SGA�� ,� * 06� as <br /> �I 1�5E OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WOHK <br /> sa.rtn�E TAM��y XEiectric Gas __Other � ZO, 000 <br /> IWORK DESCRIPTiON <br /> ,!lEMO�-ISF1 �k15'I lN4 �N(��E ��"���-� f'FMt—. <br /> i <br /> PLUMBING MECHANICAL <br /> I N0. TVPE OF FI%TURE OR ITEM N0. TVP[OF FIXTURE OR ITEM <br /> � __ Toilel _ A'C-air handling unds <br /> Balhlub ___ FOrced air Sy51em5 <br /> i Lavatory(wash basinl __.__ Gas piping <br /> IS'�ower __._ Waterheater <br /> � Kitchen sink 8 disposal __ Gas lireplace <br /> I �ishwasher _,_ Ga^ range <br /> I Clothes washer , _ _ Clothes dryer <br /> �� Water healer _ ___ Range hood <br /> � Sink�service'bar ninp:�ic 1 _ _ Exhaus�lan <br /> � Backtlow prr,venta� _ __ Heat pump <br /> �� - Unnal __ Urnt heater <br /> Dnnking Founlain , _ Boiier <br /> � Floor drain ___ Relrigera��on <br /> ��, Grease Irap __ Woodstove <br /> - — <br /> Rool drains ____ Other_______ <br /> , Olher__'_ . _. ____ _ ._'_ — <br /> i __-_ '__—_ ____ __._ '__'— '____— <br /> GTY OF EVERETT IOCAL SALES TAX CODE IS]705 <br /> � I hereby centdy Ihal I have read and e*amined U��s applicaUon and know Ihe same to be Irue antl correct All provisions ol laws and <br /> � ordinaces qoverning Ihis lype o�work will be comphed wrth whether specilied herein or nol.The grantinq ol a permi�does not presume <br /> �� to give atdhority to violaie or cancel Ihe provision ol any oR�er 5late or local law requla6ng con5iruction or Ihe pedormance ol <br /> I consirucuon Thal I am authorized by Ihe owner ot Ihis prnperty to perlorm �he work lor�Nurh appi�r,atron is made and I cnmply with Ihe <br /> I State Contractnrs Law 18 27 RCW and 29b.200 WAC. <br /> , � � , � ' lacr G�� <br /> � S�,�n3Wr o�Ow r Gon ac Authon.-ed Agent Date <br />