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� PEKMIT APPLICATION <br /> CITY OF EVERETT PERMil' SLRVIGES � <br /> 3200 CEDAR STREET, E\/ERETT, WA 98201 I <br /> 425-257-8810— FAX 425-257-8857 —v�nvw.everettwa.org <br /> APPUCATIONS A�E ACCEPTED FROM 8 APA TO 4 PM �' y�7`��� <br /> SITE ADDRESS PARCEL TAX I.D.S' PERMIT# <br /> -,�- t� � f � � <br /> "1� ( ; � Jc����iCl�l� G-���C'_��L � l�i� �l � `(l;i_�;� �t�.�J���-L�. � � .j I� ' I <br /> LEG.4L LOT NO. BLOCK TRACT 1 <br /> DESC. ' '� ��Q�\A..l' �C �Q _ <br /> nWNER R��RFS� CITY/ZIP PHONE <br /> , � �� I <br /> `> 1-��� ��1._ �� �,.I y�.,.,,,�,��� aI ��S �����.sauPL �eReT�`_ _ �$O �O <br /> TENANlNAME CONTACTFORI`ERMIT PHONE <br /> �� � � •- , <br /> ._;< tIP_ (3c.al�I �JLY= d.%',��Ja:.� =- <br /> CONTRACTOR `ADDRESS CITY/ZIP PHQNE <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK I <br /> I� �� � ��Eleclre Gas Olher � <br /> , ,,_�J : - - - <br /> WORK DESCRIPTION <br /> � <br /> � I} � , i� � , i <br /> I � X � �� �'�= I fi-; �� �-� �J�I,���l� � I aGL�'4'v 1 h z'�, �,,,v . _ <br /> PLUMBING PAFCHANICAL <br /> NO. NPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> I Toilet _ A/C–air handLug units <br /> _f_ Balhtub _ Forced air syslems I <br /> �_ Lavalory(wash basin) _ Gas piping <br /> Shower Water healer <br /> Kitchen sink&disposal _ Gas(ireplace <br /> Di;h,^,asher Gas range <br /> C;�thes washer Clothes dryer <br /> Laundp�tray Range hood <br /> Sink(servicelbadmop/etc.) � Exhausl fan <br /> Back(low preventer _ Heal pump <br /> Urir.a! Unit healer � <br /> Drinking Founlain _ Boiler ' <br /> Floor drain Refrigeralion <br /> Grease trap _ Woodstove <br /> Roof dreins _I Other <br /> j _ Other_ — <br /> I� --- — — <br /> i CIN 7F EVEREIT LOCAL SALES TAX CODE IS 3105 <br /> il _ — <br /> �� I hereby cerilify that I have read and examined this application and know lhe same to be irue and correct. All provisicns of laws and <br /> ordinaces goveming lhis type o(work will tre complied wilh whelher speci(ied herein or noL The or2niing of a permit does not presume <br /> to give aulhority lo violate or cancel the provision of any other stale or local law regulating consWction or the performance of <br /> construction.That I am authorized by the owner of this property;o perform the work for which application is made and I comply with the <br /> S(ale GonUactors Law 18.27 RCW and 296.200 WAC. ; <br /> �, . � <br /> ' I� l�:���:,� ��CL .L � � / � �G.> <br /> Signature of Ow)ter/Contractor/Aulhorized Agent / � �Date � <br /> I � ) <br /> �- — -- — ----- <br /> I ' <br />