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PERMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857- www.everettwa.org � . <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � ��� C�7 <br /> �qp�g ^ � �U� PARCEL TAX I.D.# �'I- �R��� <br /> � 4 <br /> LEGA� LOT NU� BLOCK TRACT OR SUBDIVISION N l . <br /> DESC. <br /> OWNER AUDPESS CITYIZIP PHaNE <br /> cf��7//�f��`�E2A/ I"I� <br /> TENANTNAME ,T CO TACTFORPERMIT PHONE <br /> ����9rJ�N 4�2s=�q- 7�i77 <br /> E-MAIL � <br /> TR-�aa-�Tb��qrlson( nrr��v�ccc�i�i�3� �ne�ifi . �l�3 `�'�' �?'s'7 <br /> CONTR. LICENSE N �„r, n�/ ,ry� L ("�(/ � � Q <br /> C�[1.�rt.iW i�---i T CJ I <br /> USE OF BUILDING HEAT SOURCE CONTRACI PRICE OF WORK <br /> ��v2u� -- - -- FJp � <br /> Eler,lric Gz� Other �� � <br /> WORK DESCRIPTION�J � y„ �_/�K ��iJ <br /> �lyt�r'c� �r�. Z UN/ S(�'K �..SY' �AOri't S� ( 7CJ ��_�1 rr� <br /> I-- ��w� <br /> PLUMBING MECHANICAL <br /> NO. TVFE OF FIXTURE OR ITEM NO. NPE OF FIXTURE OR ITEM <br /> �_ Toilcl __ A/C- air hancllinc� uni�s <br /> Balhlub __ Forcod 2ir syslems <br /> Z Lavatory(wash basm) _ Gas piping <br /> Shower _ Watm hcater <br /> _�_ Kitchen sink 8 Aisposal _ Gas fireplace <br /> D�shwashor _ Gasranye i <br /> Clalhes washer _ Clolhes dryor <br /> Water heater _ Ranga hood <br /> / Sink (scrvice/bar/mop/clr..) _ Exhaus�fan <br /> I Backllow prev�ntc,i _ Hoal pump <br /> �I - U^nai � Unit heater <br /> Drinking Fourdain Dailer <br /> l_ Floordrain __ Re(rigeretion <br /> I Greasc tra� _ Woodstove <br /> ' Rooi dr. i � _ Olher__ _ <br /> i _ (_ Olhcr �.�iQ��I����' ' — -- <br /> � _r . LtAA3`e���1�'QfC --- — <br /> I � GTY OF EVERE7•LOCAL SALE9 TAX CODE IS]105 ! <br /> ��i I hnreby cenli(y ih,t I have read a�d�xanined this application �nd know the same to be trao and correct. All provisions of laws and <br /> I ordinaces 9oveminc� lhis lyp��ol work will t o complied wilh wheh er specitied herein or nol.Tho qranling ol a permit does not presume <br /> I tu�ivc aulhonty�o viulale or cancel ihe prcvisiun of any other sta�e or local law regulaling cons'Iruction or tho peAormance of <br /> � r.onslruction. That I am aulhorized by ihe ow�er ol Ihis prope:ty�o pe�`orm the work for which application is mado and 1 comply wilh Ihe <br /> iSl�+te Co Uactors Law/�.27 RCIN and 296.200 WAC. <br /> :-`���i���rr.D,�c �7 3-c,7 <br /> I `,i9n,ture o Ov��dContractodAuthorized Ayent Date <br /> � I <br /> _. _ _ -�----- � --- - <br /> i <br />