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--- _ ---- - - <br /> PERMfT APPLICATION <br /> CITY OF E�ERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810– FAX 425-257-8857–www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FRQM 8 AM TO 4 PM <br /> SITE ADDRESS � PARCEL TAX I.D.# PERMI �t <br /> I �dLb ���,.Qw�, voy3�� 3b,� ozooa �'s v, o� - c3"J <br /> LEGA LOT NO. BIOCK TRACT OR SUBOIVISION k r� ^,� r ! <br /> D[SG ZJ 6 �� V�51Ce1 ��.�� 11-Cc0✓cv. 1-p Y�5{- ��ave.tt Vcl. <br /> OWNE� I \ \� —�- ADDRESS nCI7Y21P PHONE <br /> � I.C�l�1���11" ��J��nJ-ei-J I ��'��+� �0 (, l� �f�c.�l�a�h GUl'�'ef- (..� !-� `7�Gi' 1 <br /> TENANT NAM NTACT FOfl PERMIT ���� �PMaNE T� <br /> � It� ` I� O6 `�Z1-1diY �?�- ZS`�-G/�`7C' <br /> � {-l�Cc �� Ui.�n��/ �� �,�LG� Z E•MWL h: H;11.�'i':..�Lkof'.w.tl.. <br /> I o�f� o � N <br /> CONTR.LICENSE p <br /> USE OF BUILDING I HEAT SOURCE � � I CONTRACT PRICE OF WORK <br /> ����,51���nL-, Cu�-i � �I��ft`:"� _Eleclric __ Gas__Olhcr �� G � W"� <br /> � <br /> 1 l <br /> WORK DESCRIPTION <br /> j 1 <br /> C_e�.-�� I��'ti� �" - <br /> � MECHANICAL <br /> PLUMBING <br /> N0. TYPE OF FIXTURE OR REM NO. TYPE OF FI7(TURE OR ITEM <br /> Toilet /VC-air handling unils <br /> BalhWb Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower _ Waler healer <br /> Kilchen sink&disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clolhes dryer <br /> Water healer Range hood <br /> Sink(servicclbar/mop/cic.) _ Ezhausl fan <br /> 8ackflow prevenler _ Heat pump <br /> Urinal _ _ Unit healer <br /> Drinking Founlain _ Boiler <br /> Fioor drain Retrigeration <br /> _ Grease trap _ Woodstove <br /> Roof drains _ Othcr_ <br /> Olher_ _ — — <br /> CITY OF EVEHETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritity lhat I have reaJ and examined Ihis applicalion and hnow lhe same to be Irue and correcl. AII provisions of laws and <br /> ordinaces goveming Ihis lype ot work will be complied with whelher specified herein or noL Thr,granling of a permit does not presume <br /> to c�ive authorily to violale or canc�l the provision of any other state or local law rec�ulatinc�conslruction or the per(ormance of <br /> construction.That I am aulhorized by lhe owner of this property lo peAorm Ihe work(or which applicaGon is made and I comply with Ihe <br /> I Slate tlors L RCW and 296.200 WAC. <br /> , i D 7�IS�d' <br /> . naWr . r clodAulhorizcd Agenl ale �/� <br />