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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-wwvv.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERM N <br /> 2C° 2 � �ti'`�.�� �L� va ,�zYb (lolZd'o S lc - OQ.3 — <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION N �( p F <br /> DESC. GL� /Z � / ��.ou �,cE�� /��- pf.�f-/�lk�6i� � -�v c�rri. <br /> OWNER ADDRESS CITY2IP PHONE + �,1�_ <br /> �G S Cii2 Fi9��v��1c�e+'1 ZC9 2,'� J�h�-r.�a�. ���kt `��Zw� T �03��1� <br /> TENANT NAME CONTACT FOR PERMIT PHONE L+•2S ' �i0'3 - �'l��-p <br /> t--'5�1�---r 6`^i�'�-1.��^ '.n v�C��l..l,� /� E�NIAIL �KG'-�� �SrQ-`�• t <br /> S2t � �8 C1TPlZfR <br /> CONTR.LICENSE p <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �j-(��C�is�., �,j., � � �sS _Eleclric �Gas_Olher G�i�,�� � �.e.� <br /> � v�a� <br /> WORK DESCRIPTION <br /> ( �1 S� l 1 S'� S 11 C9-� �CC, ��/' � C� .. <br /> �/ <br /> PLUMBING MECHANICAL <br /> NO. NPE OF PI%TURE OR ITEM NO. I— TYPE OF FIXTURE OR�TliM <br /> Toilet _ NC-airhandlingunits <br /> BathWb _ Forced air syslers <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kilchen sink 8 disposal _ Gas(ireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Waler heater Range hood <br /> Sink(service/badmop/etc.) Exhaust fan <br /> Backflow prevenler Heat pump <br /> Urinal Unil healer <br /> Drinking Founta�n _ Boiler <br /> Floor drain ReMgeralion <br /> Grease lrap Woodstove <br /> Roof drains Other _ <br /> Other <br /> � <br /> CITY OF EVERETT LOCAL SAIES TA%CODE IS 7105 <br /> I hereby cerility that I have read and examined lhis a ' ' and know the same to be true and curtect. All provisions of laws and <br /> ordinaces governinc�this rype of work will be c ied with whether specilied herein or not.The granting of a permit does not presume <br /> to give aulhwiry lo vielale or cancel the isior of any other slate or local law regulating consWctien or the pedormance of <br /> constru ' .That I am aulhorize lhe mvner o(this property to perlorm he work for which application is made and I comply with the <br /> Sta� tracl r4 Law 18.27� and 296.200 WAC. <br /> / ;7 � � <br /> Sig lure o(Owne nlractor/Aulhonzed Agent Date �/-7 <br /> / -- _ C. <br /> / <br /> —L..� <br />