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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 <br /> SITE ADDRESS PARCEL TAX I.D.M �ERMIT N , <br /> IZq �r2'`� sr sr� z� o�F�� e oo �5 Cr%n ;� �''�' <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> Cnc^�y� f IJAI�Ly ID�MS 729 l�Zr`. sT 5� E����71" Ff2eE <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> � IGc�r�i , rc, .5 �—�-�- l,&,vi•� GnY 'Lob • boR • a2z0 <br /> CONTRACTOR � ESS CITY2IP PHONE <br /> r. <br /> CONTR.LICENSE M I q, � �//�i Y '- `-7' <br /> � Q�! <br /> USE OF BU �1ING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �n t' F('�� _Electric _Gas_O�her zj� L�C <br /> X/�� <br /> WORKDESCRIP710Ni1nmoNr,J �q �elGCo�vh�n .oaf,n� -�rtia� � i�y , U'r� l/f7 OJIL <br /> L1�/-f-p�.�i .v�on�T �.�r-rh $MP�� 2.�O�o ��.b. nC.1- . <br /> � �/l /� s�j l�" W /�'�- S � ��D - On, -- <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM N0. riPE OF FI%TURE OR ITEM <br /> Toilet A/C-Tu handling unils <br /> Balhlub Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Water healer <br /> Kilchen sink 8 Aisposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothe=washer CloOies dryer <br /> Laundry�ray Range hood <br /> Sink(service/badmop/e�c) _ [xhausl lan <br /> Backllow preventer Heat pump <br /> Urmal Unitheater <br /> Drinkmg Fountain _ Doiler <br /> Floor drain Reingeration <br /> Grease lrap Woodstove <br /> Roof drams Other_ <br /> Other <br /> CITV OF EVERETT LOCAL SALES TA%CODE IS J105 <br /> I hereby ceritify that I have read and examined this appl�catlon and know the same lo be hue and correct. All previsions ol laws and <br /> ordinaces govemin�Ihis type of work will be complied c�ith whether speufied herein or not. The granting ol a permit does not presume <br /> lo give authonty to violate or cancel Qie provision ol any other stale or loral law regulating construction or ihe peAormance of <br /> consUudion. That I am au0iorized by the owner of Ihis property to perlorm the work lor which application Is made end I comply wilh ihe <br /> State Coniractors Law 18 27 RCW and 296200 WAC <br /> j , —.� �� , � �/ z,a :'ob <br /> , <br /> ISgnalure o(Owne Co� r8c�qr uthOnzed gent Date <br /> , � r � . � � <br /> I - - ------- <br />