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�— <br /> P�RMIT APPLICATII.�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, E�IERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 - www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> S�TE ADDRESS �� � ' '� � PARCEL TAX I.D.# PERMIT p <br /> v ; ���� �'��/) ' � � �j � - ���hccl��'1 �s,. ,<5 � l}G'2 <br /> f l l_ 1r rl- � � � < < <br /> LEGAL LOT N0. BLOCK TRACT OR SUBUIVISION p <br /> DESC. � y,�.,,�.-, <br /> OWNER ADDRE55 CITY/ZIP PHONE -c .+�O� <br /> � 4`1 'Y 'Y. <br /> I��, �-<< l�' � f: ���-�:,.,,, � > .� , « ny r, » � v� r.� r-r �� �� j <br /> TENANT NAME CONTAC7 FOR PERMIT PHONE ���� � �,; . � ,.� t <br /> � � i i <br /> ��C1�'�� I�- ( �� <-� � ` � � l�r���.i �� i�csSG/C� E•MAIL <br /> I . <br /> 5 � i I 5 � �t :�,-�i�r K��1 �,�r4 <br /> CONTR. LICENSE Y. � >>L .� � C�. �, .` � � V �� } f� .5��. � I �1 )� c;' 1� / <br /> � USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> , <br /> �!� _Eleciric _Gas_Olher ���� I�' G X<L � /� �� 6 C� �.-� �� <br /> i <br /> WORK D SCRIPTION <br /> L,..�-r �i i; � ,i^ �, � C, C <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIKTURE OR ITEM NO. TYPE OF FII(TURE OR ITEM <br /> , Toilel NC—air handling units <br /> � DaQitub Forced air systems I <br /> __ Lavalory pvash basin) Gas pipinc� � <br /> Shower Waler heater <br /> _ Kitchen sink 8 disposal Gas(ireplace <br /> Dishwashor Gas range <br /> Clolhes washer Clolhes Aryer <br /> Waten c�aler _ Rangc hood <br /> Sink (serviceibadmopletc.) Ezhausl fan <br /> Oackllow prevenlur Heat pump I, <br /> _ Urinal Unil hcaler i <br /> Drinkiny Fountain Boiler <br /> Floor drain Relrigeralion <br /> Grcaso Irap Woodstove � <br /> Roofdrains � Othor ��•� t '� 5 *"����C C <br /> Olher <br /> CITY OF EYERETT LOCAL SALES TA%CODE IS J705 <br /> I hereby cerilify Ihal I have read anA ezamined this application and know Iho same�o be true and correct. All prmisions ol laws and <br /> ordinaces govnming this type ol work will bo complied�vith whelher speci(ied h�rein or noL Tho g�anling of a permit does nol presume <br /> to yive aulhorily to violate or cancel Ihe provision of an��olher state or local law regula�ing conslruction or the pertormance ol <br /> conslruction. That I am aulhorized by Uie owner ol Ihis property�o perform iho work lor which applicalion is made and I comply with iho <br /> Slate Conl actors La 1 `27 RCW and 296.200 WAC. i <br /> ' ��� f �� f �, I <br /> /; �;,/: !'' ,�-- l / - C�Cj i <br /> Siynaturc of Owner/ContractodAulhorized A9en1 Dato , <br /> I _ ._ __._ . _ _ . .. . . . — --- -------------- � <br />