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PER�VIIT APPLICAT'ION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98?.01 <br /> 425-257-8810- FAX 425-257-885,'-v�nvw.everettwa.org <br /> APPLICATIONS ARE ACCEPTEU FROM e AM l 0 4 PM ��� 'Cb(� <br /> SITE ADDRESS . PARCEL TAX I.D.# PERNII # � <br /> 3C:z� l.�(Q�C�l�lx'�� �n'�� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVIS�ON k <br /> DESC. <br /> OWNER ADDRESS CITYfZIP PI ONE <br /> TE ANT A E� N��c'l�`� �u��7 �AtCT FOR PI RMIT PHONE �1�� c S �' C A��^. - �� <br /> ��/I.LA--`�-�/C`7�-��fl.t 21�1_.� V 1 r ���IL�-� (�� !� - f t•MAIL 1�� F'�1( lQl')1lcc�eL� -1� <br /> CDNfRAC/TQ) R„ � A DR S� ITY/ZIP H NE �� ' <br /> � � ��I/ I \ � / �--1 G� - �L% J -I �Z <br /> C'NTR.LICENSE# � " � ��, L C���j S''I-��� I <br /> �. _ <br /> USE 0�BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> EIecL'ic Gas Other �- <br /> WORK DESCRIPTION • � �� <br /> / ���� <br /> ,. �/ � ,��)� ���; i � � Da . ,_ � i <br /> �,- � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE CR ITEM <br /> Toilet � AIC-air handling units <br /> Bathtub � Force�air syslems <br /> Lavator�(wash basin) _ Gas piping <br /> Shower _ Waler heater <br /> Kitchen sink R disposal _ Gas fireplace <br /> Dishwaslier _ Gas rango <br /> Clothes washer _ Gcthes dryer �G <br /> Waler healer __ Range hood /� <br /> Sink(service/bar/mopie�c.) Exhaustfan l%Ji <br /> Backflow preventer � Heat pump <br /> Jrinal _ Unil healer <br /> Lrinking Fountain . _ Boiler <br /> Fuor drain _ Refrigeralion <br /> G•ease lrap _ Woodstove <br /> �:oof drains Other <br /> Other — <br /> I <br /> GITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby r.eritify Ihal I have read and examined this applicalion and know the same lo be true and correcl. All provisions of laws and <br /> ordinaces�oveming this type of work will be complied wilh whelher specified herein or noL The granting of a permit does not presume <br /> to give authorty to violale or cancel Ihe provision of any other state or�ocal law regulating conslr�ction or the pedormance of <br /> conslru ion.1'hat I am aulhorized by Ihe owner of this property lo perform the work for which application is made �nd I compty wilh the <br /> Statc, nlraclors Law 18.27 RC 96.200 WAC. <br /> i / <br /> � � � � <br /> I S g lure of OwnedConlraclo h nzed Agent Da <br /> ` � L <br /> �---___ --- — <br />