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PE. �MIT APPLICATIO. . <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 FP.OM B AM TO 4 PM <br /> SITE AD6RESS � UI LrJ/N�� �� `� PARCEL TAX�.D.N ?ERMIT fl <br /> �C� I i�w.�.�' OD�1-31''3>Z (0 00/00 �1 �`�-QO� <br /> DESC. LOTNO. BzcK n- � TCut�z���SD•✓iSrvn/ � /�LfJi <br /> O ER ADDRESS CITYIZIP PHONE <br /> ,/ OpnD <br /> �,a,��t��-�zs�u�2�zs'�-��' �'a�s� �.r�, 982as .Tr;-Sbi- <br /> TENANT NAME /CO� NTACT FOR PERMIT PHONE Zy—S��'��� <br /> � /NI)IZ/1 �CjI fti � � R l",�I�L`; �C� L�IsL�( E-MAIL <br /> l.`T6 /�--AD <br /> ' C/�%i N J" <br /> CONTR.LICENSE k <br /> USE OF BUILDING HEAT SOURCE COYTRACT PRICE OF WORK <br /> �� IN,` _ ��J(� SL-72U/C'L — <br /> Electric _Gas_Other �� �sO�O <br /> WORKDE5CRIPTION k�-�,,�,��Ln 5�lI,�;�,C' J�Do�2 �1�11D /NSidLLCD A �l3i.r <br /> (-I�S-ra:ir�oL.: /� � ,/��� <br /> li 1 /t.��" "�LJ�� ��(� � 1 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C--air handling units <br /> Dafhtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heate� <br /> Kitcfien sink&disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(servicei��r/mopletc.) Exhaust fan <br /> 6ackllow prevente: _ Hea� pump <br /> Urinal Uni�heafer <br /> Drinking Fountain _ l3oiler <br /> Floor drain Refrigeration <br /> G�Aase trap _ Woodstove <br /> Rouf drains Other <br /> Olher ,_ <br /> _ —I _ i <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceAify lhat I have read and examined this application and hnow Ihe same to be true and correcl. Ail pravisions ot laws and <br /> ordinances gove ning this type of work will be complied with whether specified herein or noL The grenting of a permit does not presume <br /> to give authority to violate ot cancel the provision oi any other state or local law regulating conslruction or the pertormance of <br /> constructior�. That I am authc�rized by the owner of this propeAy to perform Ihe woric for which application is made and I compty with the <br /> Slate Co�r Uors Law 18.27 RCW and 29�200 N/AC. <br /> � 4�tL/ �/�� �l / t� '�.� — ��� <br /> Si�tuPe of on ractodAuthorized Agent Date �/,L <br />