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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CrDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857 —www.everetlwa.org r F(7 Cp� Z -cx/1 ) <br /> l <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM a —S — O 7 <br /> SITE ADDRESS PARCEL TAX I.D.it P�tM1T It <br /> l 7 !,J . G /UD ' /a 7ii/ -D� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDR�SS CITY2IP PHONE <br /> /Z�5 /Z�ii� �(-U iVr <br /> _ �.� �z� ; w��so� ,�,f�,vr �-zs- �.� - �r� �E <br /> TENANT NAME CONTACT FOR PERMIT � PHON � 7 <br /> � c�ll -20�r�>>-J(�5. <br /> �i�E.SrpF_ WF-S�- ' ;ccES � i �- Z 3- �iLr _ <br /> CONTRACTOR /�r�G�JRIQ� c"ONST ADDRE55 CITY2IP PHONE <br /> �1�.3o�2�r� i,v� � 3 �� 7 <br /> CONTR.UCENSE p 9viv9 <br /> MC r�r� �o99J7- 22� N�U[��LSo�� ��Qi�ri�i zo � - z��3- �rz� <br /> USE OF 13UILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> .�S"�r/.{f`�s I �' Elecirir. _Gas_O�har `�t}� 5�'j0.c�U <br /> WORK DESCRIPTION <br /> �Ef�i}l2 FlF'-E `pAii�A�� TL� UN/T �.� : �f•1E Gv��L ¢ /Z�oF F/Z¢Hi.VG <br /> c- c'7 (.�i(/tT 70 �77��DS A�F-t�� tcJ/2IN6� /NSUL.� C wC3 , � �GG .t/6CJ F/it//y/CS <br /> PLUMBIIvG MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. I TYPE OF FI%TURE OR I?EM <br /> Toilet _ � A/C-air handling units <br /> �a����ii�� __ Forced air syslems <br /> Lavalory(wash basin) __ Gas pipinc� <br /> Shnwer _ Watorheator <br /> Kitchen sink 8 Aisposal Gas fireplace <br /> Dishwasher G,as range <br /> Clolhes washer Clolhes dryer <br /> Walor healer _ Range hood <br /> Slnk (serncclbarlmuplr.tc � _ Exhaus� lan <br /> Backflow preventr,r _ Heat pump <br /> Urinal Unil heater <br /> Drinkin� Powit�in Boiler <br /> I _ Floor drain Relrigora�ion <br /> Grease Ir�p _ Woods�ove <br /> Roof dr�ins _ Othe� <br /> Othcr <br /> CITY OF EVEF.ETT LOCAL SALES TAX CODE IS�105 <br /> � I heroby ceritify�ha� I have read and examined Ihis application��d know Uie same lo be true and correct. AII provisions of laws and <br /> Iordinar,es governing this type ol work will be complied with whtlher speci�ied horein or nol.The granling of a permil does nol presumo <br /> to qive aulhority in violate or cancel the pro�ision of any olher s�ale or local law regulating r.onstruclion or the pedormance o( <br /> construclioR����at I.am authori�e�Y the ownnr of Ihis propeny to perform the work br which application is made and 1 comply with the <br /> � Stata Co�lfaf;tors{aw 1t3.27 R4'W,�nd 29G.200 WAC. <br /> �J� ��� <br /> ' i�% � ��l/�C�,��� <br /> I, i$�ture ol Owner/ onlractorl orizea Agnnt Dale � <br /> i �� � <br /> i . _ _ . . . _. _.. .. _ . ._--._.__------ — <br />