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PERMfT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 �EDAR STREET, EVERETT, WA 98201 f � <br /> 425-257-8810- FAX 425-257-8857-www_everettwa.org n <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> ; <br /> SITE AUDRESS I PARCEL TAX I.D.# P MIT# <br /> y839 ���vo u d 4oy3,�oo3 0 �o,o ���J,� -Gvr' <br /> LEGA LOT NO. {� BLOCK �AIRACT � <br /> DESC. ` <br /> OWNER DRESS —� CITY2IP HONE <br /> Y�/en a L4k�sfc,o�q /a��?.� /6 pL GU �ie�e�urR ��.o y�y�s'�3.z�a2 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> I C��.�..�A /���.,r o?06 �� �`d�' <br /> CONT AC OR ADDRESS CITY/ZIP PHONE <br /> G,�6E,Q�A �l3ar�f'f� Pc ��q 2 4� �f <br /> CONTR.LICENSE# 'E r`'A'Nj '�-t5� � R��..�p0"�,,��,�� ��iyrak� a-�6oC.oL�6�' <br /> C��e n'I� 76 B N �� Q`8d� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Electric ��Gas�Other :���2�/ <br /> WORK DESCRIPTION - <br /> � ec� �tiO`�`�� <br /> � — <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> , J� Toilet! — A/C—air handling units <br /> ��' Bathtub ! l Forced air systems ✓ <br /> � Lavatory(wash basin)(F; T Gas piping� <br /> _� Shower � � Water heater' <br /> � Kitchen sink 8�disposal � �( Gas fireplace� <br /> _(_ Dishwasher ' Gas range/ <br /> _� Clothes washer� r Clothes dryer�'-. <br /> � Laundry tray '?, Range hood <br /> � Sink(service/bar/mop/etc.)� � Exhaust fan 7 <br /> 1 Backflow preventer _L Heat pump <br /> — Urinal Unit heater <br /> � Drinking Fountain � Boiler <br /> Floor drain _� Refrigeration <br /> x` Grease trap Woodstove <br /> ^ Roof drai�s Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby ceritify that I have read and exa ed this application and know the same to be true and correct. AII provisions of(aws and <br /> ordinaces goveming th's type of work will ompli d with whether specified herein or not.The granting of a permit does not presume <br /> to give authority to viol cancel the pr vi ' n of ny othe�state or local law regula6ng construction or the performance of <br /> construction.That I am u 'zed b the o e of th property to perform the work for which application is made and I comply with the <br /> State ConUactors Law .2� W a d 296. 00 AC <br /> Y� <br /> `_ <br /> Signature of Owner/Contractor/Authori e Agent Date <br /> /� ( <br /> , <br /> ��J-��`�/ � <br /> � <br />