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� PErtMIT APPLICATIOiv <br /> � CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 I <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM l' AM TO 4 PM <br /> 81TE ADDR[SS PARCEL TAX I.D.p PERMIT M <br /> �2� 't-�A�� P�I���:, c,o J <br /> LEGAL LOT N0. BLOCK TRACT OR SUBDIVISION M <br /> DESC � <br /> OWNCR ADDRESS CITYIZIP PHONEuZS '7'-�0-(�,D7�, <br /> �1��� � c�✓v� t �1 �5A(Z�ARh C�J . �J�`2�=-n �r8aD3 ' <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �'-1��ycL J�.� C� . �y�F- E•MAIL <br /> �6ATRA�� . <br /> CONTR.LICENSF.N ���t�/'�-��n� I <br /> — -- — I <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK . <br /> ��f i-- _Electnc _Gas_Other I <br /> � WORK DESCRIPTION �� <br /> �i I <br /> _��-��� f, . <br /> PLUMBING MECHANiCAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM I <br /> Todel A/C -air handling unds : <br /> _ �athtub _ Forced air systems � <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Waler heater <br /> Kilchen sink&disposal Gas lueplace <br /> Dishwasher _ Gasrange I <br /> Clothes washer _ Clothes dryer I, <br /> _ Waler healer Ranga hood I <br /> Sink�serwceNadmopielc 1 _ Eahaust fan <br /> Nackllow preverler ,_ Heat pump I <br /> Unnal Unit heater <br /> Drinking Founlain Boder <br /> Floor drain ReG�gerahon <br /> _ Grease Irap — Woodstove I <br /> Rool drains Olher <br /> = O�her_ — _ = i <br /> i <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 - � <br /> I hereby certily ihal I have read and exammed Ous apphcabon anA know ihe same�o be Uue and correct All provisans ol laws and � <br /> ordinances govermng this type of woik will be complied wilh whelher specnied hernln or not The granting ol a permi�does not presuine <br /> lo give aulhonty!o viclale or cancel the provision of any olher stale or local law regula6ng cons�ruclion or the perlormance ol <br /> construcUon. Thal I am Tu�horizeA by ihe owner of this property to perform Oie work lor which applicalion is made and I comply e�i�h Ihe <br /> � Stale Gottt�actor=l.aw 18 27 RC �n �29'200 WAI. � <br /> � I <br /> i <br /> � �. '�.. ♦ �• � �� O� U 3 /C7 <br /> � Signa�ure ol OwnedConbactodAuthonte enl Dale � <br /> � <br />