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i <br /> ' PERMIT APPLICATION <br /> ' CITY OF EVERETT PERMIT SERVICES � � � <br /> j 3200 CEDAR STREET, EVERETT, WA 98201 <br /> i425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS ( PARCEL TAX I.D.N PERMIT fl <br /> 3-�v� i3cocalk'��j UC � ' DDi,�JD �� `I -�VJ"5' <br /> LEGA lQT N0. A i BLOCK TRACT OR SUBDIVISION N <br /> DESC. A�-T1•IS�h''�'uc� <br /> OWNE ADDRE55 qTY21P y NE� S OI ' bC�U <br /> �>��� I e �z.�� • � 3`70l �� rv�,� — 9ece�T1� - <br /> TENANT E I CONTACTFORPERMIT� PHONEY�S' ��Y•�/�'/�D►� <br /> SQndr� �o� -�� r �vx•sel.r� SC':.�,u.y Sc•��li, �a.A1�P� <br /> �L eaxa� • <br /> N A T R ADDRESS I I I H N , <br /> CONTR.LICENSE X -� <br /> �(>_��,n <br /> USE OF BUILDING . I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��L4'Lt�-� �t�.�� ��i�u lc n . <br /> - 1 `�Efectric ✓ Gas_Other <br /> WORK DESCRIPTION 11���� ��q� Co�Y.0 r`{.�1 � t=rx„w,.1 a� �ti.lbt� <br /> 1� C "� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet A/C–air handling units <br /> Bathtub Forced air systems <br /> Lavarory(wash basin) Gas piping <br /> Shower Water heater <br /> Krtchen sink 8 dlsposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> W2ter heater Range hood <br /> Sink(service/barlmop/etc.) Exhaust�an <br /> ! e3ckflow preventer Heat pump <br /> Y Uriral Unit heater <br /> Dnnking Pountain Boiler <br /> Flr,or dra�n Refngeration <br /> _ G�.�ease trap Woodstove • ' <br /> _ Roof drains _ Other� S(q� <br /> Other ' � d <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS�105 <br /> I hereby certify that I have read and examined this app6cation and know the same to be true and correct. HII prowsions of laws and <br /> ordinances governing this type of work will be comphed with whether specifed herein or noL The granting o(a permit does not preseme <br /> to give authonty to violate or cancel the provision o�any other state or local law regulahng construdion or the perfortnance o( <br /> eonstruction. That I am authorized by the ewner of this property to pertorm the work for N�hich application is made and I wTply with the <br /> �State Contra ors Law 1827 RCW an�c 296 200 WAC. <br /> - " ����fi.��«,�..� �liyl��� <br /> S�natur'e oFOwner Contrac or/A thonzed Agent — atC� � <br /> O l.�,ti�t \ L�� Q��rC�0 �Z. <br />..- - — <br />