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� <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR 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 7 ,. '7 �p J <br /> SITE ADDRESS PARCEL TAX I.D.N PEHMIT k <br /> s.zo h�, c�+r:,.,c �''� o0 ou� 3yoo I C"'�'�S1Z -uL� <br /> LEGA LOTNO. BLOCK TRACTORSUBDIVISIONN <br /> oesc. 3 O'�O oo �vr-�.�.Y c�i?RYTir�ecrr �; . 2 <br /> OWNER ADORESS CITV2IP PNONE _ �aNti (�v� <br /> �sLEH VNA�,roT£t=>�!r 370 / ErFcu�;✓� c� �iT. Av.r7+�J� �/�- y <br /> s v. ia i/o TX �p7 si 9S/- SZ <br /> TENANTNAME I COM.ICTFORPERMIT � PHONE q/,�S•77r/-��OU <br /> 7),Iv:p sUvA� N7cciJ .Yt�s �� <br /> /�sN�?i'+7a.. -�.2'�.T�s»'i.f+AANL /rf..,$ mT�tce.v.�vc Iw.?T, <br /> _C�SflTRA �O r�-� <br /> CONTR.LICENSE N <br /> USE OF BUILDINO HEAT SOURCE CONTRACT PRICE OF W RK <br /> Ri <br /> �.�-,�,,yj�1 �.�.��r ��Z ?�Eledric _ Gas__... O�her � J o U <br /> WORK DESCRIPTION � <br /> y wr rTifL!_,/i.�-jp�a �f /���W 7,�ci._� 1"�s71i n-6� /QFi�-evi 1 <br /> �.'��- 7cc.'_��Jl`i�tS� =^.Y�"Ar_�:+Y>Ji+ sf /1'e=W ri�Y'-!c6G4S.f /.�Gr�.)f�l'c'R�iL <br /> ON �,)T ^ON Oj A.fci/Y. <br /> PLUMBING MECHANICAL <br /> N0. TVPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A�C-eir handling unils <br /> �athlub Foroed ai�systems <br /> Lavatory(wash basin) . Gas piping <br /> Shower Water heater <br /> Kltchen sink&d�sposal Gas lireplace <br /> Dishwasher Gas rangc <br /> Clolhes washer Clo�hes dryer <br /> Water heater Range hood <br /> Sink(servic�!bar'mop'McJ EMhaust lan <br /> Dackllow preventer Hea�pump <br /> Urinal Uni�heater <br /> Drinking Poun�ain Boilor <br /> Floor drain Refrigeralion <br /> Grease irap Woodstove <br /> I Rool drains ... Other _ .. . . . <br /> Olher . _. _. . _.—_ . <br /> i <br /> . . . __ _--____--__ . <br /> ICITV OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> � I hereby cerilify ihat I have read end eKamined this epplicalion and know ihe same to be�rua and correct. All piovisions ol laws end � <br /> ordinaces govern�ng this type ol work will be compliad with whelher specilied herein or noL The granting ol a permi�does not piesume <br /> to give aulhoiiry lo violale or cancel the provision ol any other state or local law regulating constmction or Ihe perfoimence of <br /> cnnsiruction That I am authorized by�he owner of Ihis propeAy lo Derlorm Ihe work lor which npplication is made and I comply with Ihe <br /> State Co actors Law 1B.e7 RCW and 296200 WAC. <br /> -- _.. S 0 <br /> ignature nl wned ontractor/AuthonzeA genl at �/� <br /> �- Z� <br />