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PERMIT APF�LICATION <br /> CITY OF E�CRETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.e��erettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM / �/'7_O� <br /> SITE ADDRESS PARCEL TAX I.D.� ERMI <br /> ,J'",:�C�rL-6•_ G�: c, �' �� OC� • o?PX� O OU � , b! -c} <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRESS CIN21P PNONE <br /> ��lTl-./1P/1/Cf Ra T�'f111' ///�/ CU� 7%N S%Ye3% /I��iTd.J. GJfl `f��c1//- 7,��-j <br /> TENANT NAME CONTACT FOR PERMIT PHOYEa-�-+ � �r ��1� <br /> o'ZG�:' $/O -CX7 S�5� <br /> tJ✓%� �i JlIY1 � EMAIL� �r �'.� f� i <br /> " � p � � ` Cn.. _ `L.Cc.� <br /> �/�'.c9/4� CG.JF/2i�L. /�// /C.'Si i(/Ct/ y,,«..��.e..v 9Suii .�S.r'-.S7G- yrI33 <br /> CONTR.LICENSE A �D,�� v Q <br /> �'/'�!'/�CGi��/G�"J —� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> 7 / p7 <br /> ��%/�/� (���n�7lt/lC AL —EleclriC __Gas_Other / L 7Jr.6.,J <br /> WORK DESCRIPTION � � � ' itJ.ECcJ cil i�'i� 2 <br /> /.✓si/.'��. �%���.���,-�_ /%'c,nc �.csrr�.�%i s��F'��1 iv C <br /> /,•J37���<- N�L�J /QG �'v`�C.aw���uSr'/Z- /�=ci� S�NLrf-iC- �.caM <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXFURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet � A/C-air handling units <br /> Bathtub _ Forced air syslems <br /> Lavatory(wash basin) _ Gas piping <br /> Sh�e�er Wa�er healer <br /> Kitchen sink&disposal _ Gas lireplace <br /> � Dish��asher __ Gas range <br /> Clolhes washer _ Clo�hes dryer <br /> Water he;ar Range hood <br /> Sink(service/badmop/etc.) _ Exhaust(an <br /> Backflow preven!er _ Heat pump <br /> Urinal _ Unil heater <br /> _ Drinking Fountain Boiler <br /> Floordrain _ Refrigeralion <br /> _ Grease trap Woodstove �_ <br /> Roof drains � Other �C.:u-C�Y� <br /> Other — — <br /> CITY OF EVERETT LQCAL SALES TA%CODE IS 3105 <br /> I hereby cer�li(y that I have read and examined this zpplication and know�he same to be true and correct. All provisions o1 laws and <br /> ordinaces goceming this�ype of work will be complied with whether specilied herein or noL The granling of a permit does not presume <br /> to give aulhority to violate or cancel Uie provision of any other state or local!aw regulatiny co�slruction or lhe performance of <br /> conslruc�ion.�a�l am authorized Cy ihe owner of tliis property�o pertorm�he work for which application is made and I comply with ihe <br /> State ContraEtor Law 18.27 RCW �296200 WAC. l <br /> � - ' �...� / %G �,P' <br /> Si � lure of wnedContractod Ihorized Agenl Date <br />