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PERMIT APPLICATION <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 <br /> SITE ADDRESS �' � I .� �'- I �•*•t�( � A�c PARCEL TAX t D.# PERMIT# I <br /> � �,�. � �� , T �� �� �j��� ,,, , oo �3"Ig5 `�3o1100 � -- <br /> LE�AL LOT 0. B�4OCK TRACT OR SUBDIVISION p <br /> DESC. II �. 1Z 5 �t � Ev �.2�ZT '���J 1 PLA'T -- <br /> �. <br /> OWNER ADDRE55 CITYIZIP PHONE <br /> f � n � � 2•i 1Sb -23 �7� <br /> �N � j !� �u�t..�.� � • f42 � r ��-hv� AvE £v��Ti (=1 <br /> , `t�s � — <br /> TENANT NAME� CONTACT FOR PERMIT PHONEr�Jy ?5,}- 7 3'[� <br /> ' 1) � � = 1'. ; rt� i � E-MAIL k�.����,� ;<;� ���.�•,,, <br /> �aRr�a , —�6a�€s�— —�irvm <br /> , �. <br /> ( ���_;� t� <br /> CONTR.LICENSE p <br /> USE OF BUILDING NEAT SOURCE CONTRACT,PRICE OF WORK <br /> �� ��11}� �L � /�-�(', _Hoc�rir, �Gas_O�hor � �"��� _ <br /> WORK DESCRIPTION L� n�� y ��i�..� L� y F h �,� i'�"n.^ �c;`�i � I oN �' ��y F� �Ci- <br /> / � <br /> �I�" �'�: � (', �'� A._, t{ iNl� IN.r � ���E✓vT� � <br /> I � <br /> PLUMDING MECHANICAL <br /> NO. TYPE OF fl%TURE OR ITEM NO. TYPE UF FIXTURE OR ITEM <br /> � --- Tuticl --- --------- --- _ aC-air handlinc� �ni�s i <br /> I'� Bathtub ___ Forced air syslems <br /> � -- - Lavalory (wash basin� --- Gas p�ping I <br /> �� Shower Water hra�er <br /> ' Kilchen sink 8 disposal _ Gas�iraplaca <br /> I � Dishwasher ___ Gas range <br /> � Clolhes washer _ Clothcs dryer <br /> �i Water heater _ Range hood <br /> ISink(service/badmop/etc.� ____ Eahaust fan i <br /> . Oackllow prevenler __ Heat pump I <br /> i Urinal _ Unit heator <br /> Drinking Foun�ain _ Boiler <br /> Flo�•drain Refrigorellon <br /> Gre:.se trap _ Woodstove <br /> Roofdrains Olher ____ <br /> Olhor — <br /> ��i � � CITY OF EVERETT LOCAL SALES TAX CODE�S]/05 <br /> � I heroby ceritily ihat I have reod and examined Ihis application and know tho same lo be true and correct. All provisions of laws and <br /> � urdin2ces c�ovemmg�his type o�work will bo complied wilh wh�;lhor specilied herein or nol Tho granting of a permil does not prosume <br /> io yivo au�honly lu violalo or cancel Ihe provision of any olher slate or local law regulaling construclion or Ihe pertormance of i <br /> ,' construclion. Thal I am authoriznd by the owner of this property to peAorm the work for which applicalion is made and I comply wilii lhe I <br /> � ,Stato Contr�ctors Law 1H27 RG d 2D6.700 WAC. <br /> i � � <br /> i �1�,�+�-Z i-�.�.�� �7 i/ ���"G � <br /> �, SignaWre uf� +nedCon��tor��h ' ed Apen� / Dato I <br /> I . . . .. _- ---_ —._ __—_. ._____. _ <br /> —� <br /> 5��. <br />