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PEKMIT APPLICAT�ON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREEI', EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8d57 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ll� �7 `-OZ <br /> SITE ADDRESS n � PARCEL TAX I.D.# PERMIT# <br /> � � ) Ln�� �� c�S1 - o <br /> G C, l. <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION p <br /> DESC. <br /> OWNER AOURESS CITYIZIP PHONE : <br /> -�ri�%D/JL i 707 �c��G'Y �h'L EI%�—f/� �.SJ_ - .SY�o <br /> TENANT NAME , /� CONTACT FOR PERMIT PHONE y=.� ' � �' �G' �S � <br /> �G�/�(/L� J / I ��� ! 1 L.��� / ,�'� E-MAIL !ON/�.�i_ il�/)E�(/� iL. <br /> C NTRACT R � D 1TY2 P �� <br /> �'c� � <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �L �-� � G _Eleclric _Gas_Other �� �� � <br /> — �— <br /> WORK DESCRIPTION <br /> ;,v_�>���� „�J ,c,� � o 00 �yf'� �- <br /> � <br /> PLUMBING �VIECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. NPE OF FIXTURE OR ITEM <br /> Toilet � - . A/C–airhandlingunils <br /> Bathlub _ Forced air syslems <br /> Lavalory(wash basin) � � � _ Gas piping <br /> Shower \Nater heater <br /> Kilchen sink&disposal _ Gas lireplace <br /> Dishwasher Gasrange <br /> Clolhes washar Clothes dryer <br /> Waler healer Range hood <br /> Sink(service/badmop/elc.) _ Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal Unit healer <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease lrap Woodstove � <br /> Roof dreins V Other / <br /> _ Other _ �Ic�r�[ � � :��� <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9705 <br /> I hereby cerilify that I have read and examined lhis applicalion and know the same lo be true and correct. All provisions of laws and <br /> ordinaces governing this fype ol work will be complied wilh whether specified herein or noL The granling of a permit does not presume <br /> to c�ive aulhority to violate or cancel lhe provision of y3ny other stale or local law regulating conslruclion or the pertormance of <br /> conslruction.Thal I am authorized by the owner qflhis property lo pertorm lhe work tor which application is made and I compiy with the <br /> Stale ntracto�aw 18. RCW d�n 296.?, _ AC. � <br /> �>��- � ��z'� ,�'/'�/C� C�� <br /> Signalure o OwnedConlractodAuthor��Cd Agent Dato ( /Z <br /> i l <br />