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PERMIT APPLICATION <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 a -U 40 <br /> SITE ADDRESS I y l0 80+`n ar n"t PARCEL TAX I.D.# /P1�RMIT# <br /> SJIr6 �'1¢TT— oa3 Z.z.coeoZoo; / 0 <br /> LEGAQ LOT NO. BLOCK TRACT <br /> DESCf Sqe<, A <br /> OWNERADDRESS CITY21P PHONE <br /> , ZC+ Gc1MMrot?C6 \ <br /> GES t CGYL <br /> L--,-c- 4932 ,16 9-H-t, S041TL - 9fj11S yzS- Zzz—. <br /> TENANT NAME <br /> NAME CONTACT FOR PERMIT <br /> \�PHONE <br /> vN�frfZ �u5 ��lY1oL.p Gf}I T $�J (-L��, �ZS• 'LS5"5 <br /> CONTRACTOR TJ��-t r� pWN <br /> $T ,TT `jAODRESS CITYZP PHONE <br /> 1 1287 WEsr�gt�.t AJS, <br /> CONTR.LICENSE# <br /> PENrJo�-c¢ 13Q'7. S�r-r 9819 ����) yf�• o� _ <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> / <br /> 113, S—) _Electricas_Other r dJ� •=— <br /> WORK DESCRIPTION <br /> Sp,\14 , .r of ZG-1IrA laza �Xtsrrrlc� wPfv- �sjrtE` <br /> PTrj✓J Irl STAu_ rs�•n1 alftc� t ¢'>Z. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITLM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet ArC—air handling units <br /> _ Bathtub Forced air systems <br /> _ Lavatory(wash basin) Gas piping <br /> _ Shower Water heater <br /> _ Kitchen sink 8 disposal Gas fireplace <br /> _ Dishwasher Gas range <br /> _ Clothes washer Clothes dryer <br /> _ Laundry tray Range hood <br /> _ <br /> Sink(servicelbarlmopietc.) Exhaust fan <br /> _ Backfiow preventer Heat pump <br /> _ Urinal Unit heater <br /> _ Drinking Fountain Boiler <br /> _ Floor drain Refrigeration <br /> _ Grease trap Woodstove <br /> _ Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> 1 hereby centdy that I have read and examined this application and know the same to be true and correct All provisions of laws and <br /> ordmaces 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 authority to violate or Cancel the provision of any other state or local law regulating construction or the performance of <br /> construction That I am authorized by the owner of this property to perform the work for which appi cation is made and I comply with the <br /> State actors Law 1 27 R,Pffftd 296 200 WAC <br /> 4/;/ <br /> Signature o Wrier/ ontrador/ uthonz Agent —� ate— <br /> ` L <br />