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� PERMIT APPL�ICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 �D - �'1--0� <br /> 425-257-8810 - FAX 425-257-8857 -www.everellwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 HM TO 4 PM (!�"��d-��� <br /> SITE ADDRESS `7E1X�3 - ��S j PARCEL TAX I.D.# PE`RyM�IT pU <br /> icbii As.so��nn� ��ro -t1����- i//�7�� ��7� <br /> LEGA:. LOT�O. BLOCK TRACT OR SUBDIVISION p <br /> UESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> L dH�ea��y F�a� �ii - �'v �� c (�G�> sc� ,35+n�ST i?wM N9� y�S��z._ <br /> p?.6 C7 <br /> TENANTNAM[ CONTACTFORPERMIT PHONE 2S 2 '���(J <br /> �8��1 ��slYi3LLnao ��, 17A��L �`''��-S E-MAIL <br /> � �`Tal�lY� k�st2ortw�+.t� <br /> CONTR.LICENSE M T <br /> i �� �l C��"�� <br /> USE OF BUILDING � �{�^T SOURrE CONTRACT PRICE OF WORK <br /> 7,ST-��3„c�c�J �/Eloclric _Gas_ _Othor �}S cx�� <br /> WORK DESCRIPTIO : <br /> �v� x 4c, <br /> '�L�=,Z�f,t:�Aro� Cc,oca� <br /> PLUMBING MECHANICAL <br /> NO. I TYPE OF FUCTURE OR ITEM NO. TYPE OF FIXTURf OR ITEM <br /> Toilel _ A/G �a�r handlinc�unils <br /> Bathtub Forced air systems <br /> Lavalory(wash basin) Gas piping I <br /> Shuwr.r __ Walerhoa;er <br /> Kilchen sink &disposal _ Gas fireplaca � <br /> Oishwashcr .__ Gasrange I <br /> Clothes washer Clolhes dryer <br /> Waler healer Range hood <br /> Sink (sorvice/badmop/etc.) _ Ezhaust fan <br /> Backflow preveNer __ Heal pump <br /> _ Urinal _ Unil healer i <br /> Orinkinc� Fountain Doiler <br /> Floor drain �_ Re(rigeralion <br /> Graase irap _ Woodstove � <br /> I � Roof drains -- = Other <br /> Olhcr <br /> � — — -- — — <br /> ICITY OF EVERETT LOCAL SALES TA%CODE IS 7fOS <br /> I <br /> I I horeby cr,nlily Ihat I have read and examined this application and know the same to be Irue and correct. All provisions of laws and <br /> � orrJinaces goveming Ihis lype ol work will bo complied with whelher specilied herein or not. The granlmg ol a permit does not presume <br /> ��, Ip give aulhority lo viola�e ur can.:el the provision of any o�her sta�e or local law regulaling consWction or lhe pedormance ol I <br /> �i construcfion. That I am authorized by lhe ovmer of this propeAy to peAorm the work for which applicaliun is made and I compty wilh the I <br /> �� State Contraclors Law 1827 RCW and 296.200 WAC. <br /> I —�1� � '„-�.� /0%7�0 � <br /> , Signalure of Owner/ConiraclorlAuthoriaed A9enl Da�o <br /> � ��� I <br /> ; _ - - - --- --- ---- _ ----- ----' <br />