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PERMIT AF'PLICATION <br /> CITY OF EV�RETT 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 ADDRES� PARCELTAX I.D.N PER T# <br /> � �� ?l���� C� (1-Z :p��" i71<76C'jE�OC�"c7h-"'� � �� �.3 <br /> LEGA L07N0. � �L�CK TRACTORSUBOIVISIDN# <br /> DFSC. � <br /> OWNER ADDRE55 GTY/ZIP PHONE�,,6_��-rp y <br /> �ca c,;� �(�,,� � �1 r � ��`t1�1� p/ 5.� .1>�t-G�,�( �t c��/.Z <br /> TENANT NAME CbNTACT FOR PERMIT PNONE a..��- �j fJ�j /LI y <br /> I ,/ � L <br /> �`lA.I� ' �� L%f n }� L��'� �Cl 1:-�9AIL /��A� 61J/G1i/ S�.nr_ i��.C•�i�� <br /> CO ��(�,.� 'vvl ° 5-� �lv �7 � t ct �c� `�� ,.1 -%`�%-7 <br /> ,�'� 1� f-. S.ea7Y� 1, l. <br /> CONTR.LICENSE N����'1f��G ��,,.L D� <br /> J� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � ����"-]ftW���;�,,, _Electric �Gas_Other �� ,�✓p <br /> ' � � <br /> WORKDESCRIPTION � T ,� 1 Gr�u ���1,��; 1y0�1"( l `L`'�'✓t <br /> S.1���C Cy�. l.� , �� r �� ' <br /> / ,, <br /> L✓'l"l� %�ICl � �� 1 � <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM � NO. TYPE OF FIXTURE OR ITEM <br /> __ Toilet A/C-air handling unds <br />� Bathlub �_ . Forced air systems <br />� _ avatory(wash basin) __ Gas piping <br /> wer Water heater <br /> Kitche ink&disposal Gas fireplace <br /> Dishwashe _ Gasrange ' <br /> Clothes washer Cbthes drye� <br /> Water heater _[__ Ranc�e hood <br /> _ Sink(serviceroavmop/ .) Ezhaust fan <br /> Backllow preventer � Heat pump <br /> Urinal Und hea�er <br /> Drinking Fou m � _ Boiter <br /> Floor drai Reingeration <br /> _ Grease ap Woodslove <br /> _ Roo rains � Other_��f1a�r �/���- <br /> O er � <br />� — --------- --.__ __-- .... . .--_---.-_ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby centdy that i have read and ezamined�his applicalion and know the same to be Ime and correct. All provisions ol laws and <br /> ordinaces governing�his lype of work will be complied with whether specilied herein or nol. The granting oi a permit does not presume <br /> to give authority to violate or cancel Ihe provision of any other slate or local law regulating wnstruction or the pertormance of <br /> constructioa That I am a�orized by the owner ol Ihis property to perform the work tor which application i,made and I r,omply with the <br /> State Conlrac or5. 8�2� an 0 WAC. <br /> - ;-- � �//�/-� <br /> Signalure 81 Owner/ConiraclodAuthorized Agent Dale 1/ <br /> Z <br />