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; <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERE7T, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM <br /> SITE ADDRESS � ���'�'T�T PARCEL TAX I.D.# PERMIT# <br /> .��zE < < i �� �;sr, o � av.�'- ,nn1���n��n.F � 7�% -2� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PNONE / <br /> � f�i�J/ I� lS <br /> MN�r �<-i5A ��"ruYt n..' /�i"E.:39 //! "`/'a Nc 73rTnic c Z y.y - �/ 9 3 <br /> TENANTIJAME CONTACTFORPERMIT PHONE <br /> /"I/U c%�r_;!'cnlres L-t. �- �Av� C.95rY (irz ��13 Z - /fl�� � <br /> CONTRACTOR ��� CC'I�Sj/ycf['T��ti'ADDRESS CITY2IP PiiONE l <br /> 7fi �V.C��'i T �/4'2 S / I <br /> CONTR.LICENSE# �\/ � C� ��'—; k'H ��O` y't <br /> D Avt. Sr �k:rOFs 232 — �fSO�I- <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Eleclric �[Gas_Olher ' O v � �S— <br /> ���c 7�r � r. � � vY) �n ut'<,rT ,.+q _ — <br /> WORK DESCRIPTION <br /> �5�/n� <br /> f��G�� i3�*��l� lz J c) n1 S' <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF fIXTURE OR ITEM N0. TYPE OF FI%TURE OR ITEM <br /> ,2 Toilel _ FVC-air handliny unils <br /> � Dalhlub _ Forced air systems <br /> r-� Lavalory pvash basin) = Gas piping <br /> �J Shower Waler healer <br /> � Kilchen sink 8 disposal = Gas(ireplace <br /> Dislnvasher Gas range <br /> � Clolhes washer _ Cblhes dryer <br /> � Waler healer Ran�e hood <br /> Sink(service/badmop/etc.) �_ Exhausl fan <br /> 8ackflow preventer _ Heat pump <br /> J_ Urinal _ Unit heater <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeration <br /> Grease lrap _ Woodstove <br /> Raol drains Other <br /> Olher <br /> CITY OF EVERETT L.00AL SALES TAX CODE IS J105 <br /> I hereby ceriti(y that I have read and examined lhis applicalion and know the same to be lrue and correcL All provisions of laws and <br /> ordinaces governing lhis type ot work will be complied with whether specified herein or noL The granling of a permit does nol presume <br /> to�ive authority to violale or cancel the provision of any olher state or local law iegulating construction or the performance o( <br /> consiruction. ihal I am authorized by Ihe owner of lhis property to perform ihe work for which application is made and I comply with the <br /> State Contraclors Law 18.27 RCW and 296.200 WAC. <br /> / J i ,� /�r,.�. / /// / !) 7 / <br /> .Sigrftureo wned onfra�dnlhorizedAgent Date 1 <br /> "L I <br />