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P�RMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —v,nvw.everettwa.org <br /> � APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> �7'7 �Yaa��w� Sv��o � �� , <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWN[R AGDRESS CITY2IP PHONE .� ` <br /> 'L,� F�,�,o_ �i� � � zL �'7��ic�o✓��. �U.e.u.� �- l� f�., � —31� -S��'d <br /> TENANT NAME CONTACT FOR PERMIT`� PHONE (iZ j-_ �(�r,�)(, o <br /> T <br /> / 1��I/�i KC ! {2 �7 � � 1y�J ES I M����l ITY/ZI E•MAIL PH E w <br /> -c�r7-'-�'� (.</1.�;, � U � (-twY 5 4 ./-� C7 n n vw-,�� ✓-!' <br /> CONTR.LICENSE q <br /> WN�7i:C9� �J76 � J 9�"d` 7 �Z1— '7K11— O7 6 0 <br /> USE OF BUILDING HEAT SOURCF � CONTRACT PRICE OF WORK <br /> _Eleclric _Gas_Olher '' 9 p vo `--- <br /> 7 <br /> WORK DESCRIPTION �1 <br /> �I}��'�7� G��il9/9P� }U-�lti �;'��.� <br /> 8 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. IYPE OF FIXTURE OR ITEM I <br /> Toilel A/C-air handling unils �' <br /> Bathlub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater i <br /> Kilchen sink&dispnsal Gas firep�ace <br /> Dishwasher Gasrange <br /> Clolhes washer Clolhes dryer <br /> Water healer Range hood <br /> Sink(service/badmoplelc.) Exhaust fan <br /> Backflow preventer Heat pump � <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Relrigcration <br /> Grease trap Woodstovo <br /> Roof drains Olher <br /> Other _ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I herebY ceritify thal I have read and ezamined this application and know the same to be true and correct. All provisions of laws and I <br /> ordinaces governing lhis lype of work will be complied with whether specified herein or nol The granting nf a permil does not presume <br /> to give authority to violale or canr.el Ihe provision of any olher state or local law regulating conslruction or the peAormance of <br /> conslruction.That I am authorized by lhe owner of this property lo periorm the work for which application is made and I comply with the i <br /> Slate Conirector Law 18.27 RCW and 296.200 WAC. <br /> ,�,= � 9� '7�� � �^ � <br /> Signature o wnedC ct /Aul z Agent Date ��, �, <br /> � <br /> � <br />` --- <br />