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3 .zz�o� <br /> PEFtMIT APPLICATIOIV � <br /> CITY OF EVFRETT PERMIT SERVICES <br /> 3200 GEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.A �RMIT N <br /> ,� �_.' :�•,� (�r����c �� �?� �i� a 2v 3�e.�ii�a �/U3 `�� <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER AODRESS CITYIZIP PHONE <br /> �—V ��� �� II 1?lu�iS LlC l 'l I, ,,�„ `-� 1 c�. �i.u� 1� I '�C I �� �I (•;i2� Hr t �'/y(o <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> � �,./'<.( �%� ' k�� c�.S ��lz�, 1 y8�-S`�ov <br /> r-t�t ,:�c. nr(�j <br /> ADDRESS � CITY2IP PHONE <br /> CONTRACTOR I/ 1 S, � I)i<< IC'�C !.� �= "' _ ��u, �t:E <br /> / 7_„�7 �,�+!� r� «- , 5+r D <br /> coHra.ucer+sea � c �iof h� 11 �..��I `)fi��ll l�/,,���/5`I S`i�o <br /> �i�i:�irr� � i.��s �zr� -- <br /> USE OF BUILD�NG HEAT SOURCE CONTRACT PRICE OF WORK <br /> �r<i y� ��, � „�� X Eleclric _Gas_Other I � . . <br /> WORK DESCRIPTION <br /> 1 �� � n��-q��� <br /> i �FZ < �i� r�� anr< <'�'�/t,�� .'icc �5 7� c'J�lc: ' �U �t.�� <br /> — PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilot _ NC–air handling unils <br /> Balhtub _ Forced a�i systems <br /> Lava�ory(wash basinj _ Gas piping <br /> Showor _ Water heater <br /> Kilchen sink 8 disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clothas wa�her _ Clothos dryer <br /> Walor hea�er _ Rango hood <br /> Sink (sorvice/bar/mop/otc.) Exhausl fan <br /> BackOow preventcr _ Heal pump <br /> Urina� _ Unit heater <br /> I Drinking Fountain _ Boller <br /> Floor drain _ Relriperation <br /> Grease trap _ Woodstove <br /> Roof drains _ Othor_ <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS�105 <br /> I hereby ceritily that I have read and examined Ihis a{�plicalion and know the same lo be trua and correct. All provisions of laws ard <br /> ordinaces govern�ng ihis typo ol work will be complied with whelhor specilied horoin or nol.The granting of a permit does nol presume <br /> lo give authority to violate or cancel the provision of any other state or local law regulating conslruction or the peAormance ol <br /> conslruction. Thal I am authorized by the ownur ol lhis property to periorm Ih�3 work lor which applicalion is made and I comply with lhe <br /> Slate Contractors Law 1827 RCW and 296.200 WAC. <br /> !� ' �C • )� C3 J + C� <br /> ��i �(t'�/ri i3 _ <br /> SignaWre of OwnedContractor/Authonzed Agenl Dale <br /> I _ --- -- ---------- --- <br />