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i <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA Sd201 <br /> 425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATtON3 ARE ACCEPTED FROM 8 AM TO 4 PM <br /> gITE�,ppREgg PARCEL TAX I.D.N PERMIT N ...— <br /> n <br /> ii�z� ;. JG%/� " <br /> LEGAL LOT NO. BLOCK TMCT <br /> DESC. <br /> OWNER ADORESS CITY2IP PHONE <br /> �- �i � iY�y ���p«+ R� E�eret�I98aoi aSa- �I�`�-33ai <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> � - li I �ac� F�rk�n5 Sv3- (�I� �(a(���- <br /> CpNTpAC7pp ADDRESS CITYRIP � PMONE <br /> �/cunj �lectr�c.S��nCo. io5.35 ��. AJcry 7u41ai��� 9�OG�� 6o3-(u�� •l�le�,2 <br /> CONTR.IICENSE M�����E�I�1�d F <br /> USE OF BUILDING I HEAT SOURCE ( CONTRACT PRICE OF WORK <br /> �, A M ti�e r�C� 4 1 _Electric _Gas_Other ��'�ndQ <br /> WORK DESCRIPTION . <br /> Remca.�e Ex�Si���� 5�-���c.Re I✓!�� 5 �,.`k�t�� � � I��ernally Illur.-,�,��+e� <br /> J i„�c. t 1 ��5p1�y <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIX7URE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Tdlet _ NC-air handling units <br /> Balhtub � Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Watar heater � <br /> KOchen sink 8 disposal _ Gas fireplace <br /> — Gas ra e <br /> / <br /> Clothes washer _ Cbthes dryer �� �, � ' <br /> _ L�untlry tray _ Range hood �� � () <br /> Sink(service/badrtwp/ela� _ Exhaust fan I �J �T, �� <br /> Backfiow reventer _ Heat pump � D <br /> Urinal P � _ Unithealer �� � �'O <br /> Drinkin Founfain Bdler � <br /> Refrtqeration <br /> — Floord ain _ �/� � p �� \ �� �� <br /> Grease trap � _ Woodstove a <br /> Roof drains _ a� � <br /> ar,er — <br /> _ — ' ��� � � � <br /> CITY OF EVERETT L.00AL SALES TAX 60DE IS NB5 � <br /> I hereby ceritify that I have read and examined this application a�know the same to be We and cortect. All provisions of lews and , <br /> ordinaces goveming ihis type of work will be complied wilh whether specfied herein w rwl The granting of a pertnil does not presume <br /> to give aWhority to violate or cancel the provision of any oMer state a local law regulatdng consWd'wn or tbe peAormance of <br /> construdion.That I am autFwrized by tha owner of this property lo perEorm Me work fw which applica:bn is made and I comply with the <br /> State Con actors Law 1$�27 RCW and 296.200 WAC. <br /> f�---- �J��-q/ot� <br /> Signature ofiOwner ntrodor/Auihonzed nt Date �/,'� <br />