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� PERMIT APPLICATIO � ��' ;;::;• ;'? �N/ i� <br /> ; <br /> � CITY OF EVERETT PERMIT SERVI � ,( � <br /> 3200 C E D A R S T R E E T, E V E RETT,WA 98201 �����4 <br /> 425-257-8810— FAX 425-257-8857—www•everettwa.org 6--/� <br /> G;7Y OF EVERE7T <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 P41�oinNPrinqlPubht Serv1 6 <br /> SITE ADOHESS PARCEL TAX I.D.� PERMR Y <br /> �- f�fCl2l��- tl-t'e� �`�i GDD lG� � �-, - _ �.�ci <br /> LEGA LOT NO. BIOCK IAACT OR SUBdVIS10N M <br /> DESC. <br /> OWNER ADDRESS pTVZP PHONE <br /> �efl��iz�.r�� 3�-I Ric�v sfr�ef �ue�e� g8�� a5a- i-m� <br /> 7ENANf NAME �'*ACT Fs,�PERMR� PlIONE O� 7 d O <br /> I�JQCG �Ua,f'U�S E�u�iwfwa�e�'y ou �' � <br /> w�sf+wU�n� �v�r�-�i� ��.c k�c�' s ���g <br /> �.���E� op pde�lcvuc l,�a 98�5 <br /> r ���� � <br /> HEAT SOURCE CONTRACT PRICE�WORK <br /> USE OF BUILDING � " I �� <br /> i�J����,�n x'1� I —Electric �Gas_Other ���. <br /> 1 � ��. � <br /> WORK DESCRIPTION �'�� <br /> �,���� � � ��� ������ <br /> PLUMBING MECHAMICAL <br /> Np. 7rPE OF Fl7(TUHE OR 17EM NO. TYPE OF FlXTURE OR REM <br /> I = Toilet = A/C—air hardling unifs <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) G����" <br /> Stwwer = Waterheater <br /> I _ Kilchen SiMc&disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clolhes washer _ Clothes dryer <br /> Water heater ,_. Range Fwod <br /> Sink(servicelbar/mop/etc.) _ E�:haustian <br /> BacMlow preventer _ Heat pump <br /> Urinal . � _ Unit heater <br /> Drinking Fountain _ Boi�er <br /> Floor drain . _ Relrigeration <br /> � Grease irap _ W�dstove <br /> Root drains _ Other <br /> Otner — <br /> CITY OF EVERETT LOCAL SALFS TAX CODE IS 3105 <br /> I hereby ceritity that 1 have read and examined this applica6on and kraw the same M be true and correct. A��Dro�isions ot laws and <br /> ordinaces govemirg this type oi xrork will be complied vvith wF�ether spec'rfied herein or not.The granting of a pertnR does not presume <br /> to give autMrity to violate or cencel the provision of any other state or local law regulaling constrtiction or Ure performance ot <br /> conslniction.That I am aulhorized by the o of this property to peAortn the Nrork for which applicalion is made and I comply with the <br /> State-CoM�actors Law 18�2j RCWMrd 29R� WAC. <br /> — �-��`tCU ����I' �� ' �� . <br /> Sg � wre of OwnedCont odAuthonzed Agent Date <br />