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� P�KMIT APPLICATIO� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, W�98201 <br /> 425-257-8810— FAX 425-257-8857—www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# nPERM/I�T(# <br /> � ��—�� '� u ��P C=:��l�5- �-1 u - u'3� - � � Gc-' I ( i�(l7 ��� <br /> LEGAL LUTNO. BLOCK TRACT <br /> D�----�` <br /> OWNER ADDRESS CITYIZIP PIIONE <br /> (� i , � � ,l ��,'�i` � !:• l r 'l <br /> _�•.� �ii ` �� -:: � �1�>_��:a�- , �-�-: n�-�, fa.,<;� i� �'I l���l ,c%�� �11��1L13 -lllsi <br /> TENANi NAME CONTACT FOR PERMIT PHONE <br /> l�y� 1-� �.:>�t�� ti�� - -,�+a � � �� <br /> CONTRACTOR AUURESS CITY2IP PHONE <br /> �-� c'.��.�t=- �. �\',r.,�1)1�IS<"��LLC_ �—IC�`�J.' �JJ�`��:t.�:�F 1��,'�'��.e.11�lSU � �l�-� � 143 <br /> CONTR.LICENSE# � l �I l`a' <br /> USE OF OUILDING HEAT SOURCE ( CONTRACT PRICE OF WORK <br /> ' ;`n_;��c �'- � 1�„1�•, �t11.;r 1:. .:� _Eloclric _�Gas__Olher <br /> WORK DESCRIPTION <br /> I--' e �.� e ..,wil l-i.�.� y-.utiti ..d' ,•� :i.i.�..�t�_ �p.,�-�.. L.1 .JL��U�.��,��-� <br /> u <br /> l 3G.-y.[.-# I S`i <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> '?Z Toilcl _ A/C-air handlinp unils <br /> l, Balhlub _.L Forced air sysloms <br /> � Lavatory(wash basin) _� Gas piping <br /> � Showcr Walor hoaler <br /> � Kitchen sink 8 dis��osal _ I Gas liraplaco <br /> � Dishwashcr _� Gasrango <br /> Clothes washcr _� Clolhos dryor <br /> Nlalr.n c�aler _� Ranc�o hood Ivl�a�, <br /> Sink(scrvicolbadmup/ulc.) _� Exhausf lan <br /> Backllow pmvent��r Heat pump <br /> Urinal Unit hoater <br /> Drinkin� Pounlain Boiler <br /> Floor drain Relrigoralion <br /> Groasa trap Woadslovo <br /> Roo(drains Othor <br /> Other _____ <br /> CITY OF EVERET7 LOCAL SALES TAX COUE IS 7705 <br /> I hereby cerilily lhat I huve read and examinod Ihis applicalion and know tha samu to Uo trua anti correcL All provisions of taws and <br /> ordinaces�overning Ihis lype o�work will be complied wilh whe�her spocifind horein or nol.The flranliny o(a pormil doas no�presume <br /> lo�ive authority lo violalo or cancel lho provision of nny olhor sla�o or local law rogula�ing construclion or Iho paAormance of <br /> construclion. Thal I am authorimd by tho ownor ol Uiis property to poAorm lho work lor which application is mado and I comply with tho <br /> S�alo Contradurs Law 1N.27 RCW and 29G.200 WAC. <br /> �. .�.. ��� .Zv_�_���.� �.U_�..��_ <br /> Si�nalure of OwnedConlractor/A�tlli �zcA Agont �Dalo <br /> —-----_.----�-- ' <br />