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PERMIT APPLICATION <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 FROM 8 AM TO 4 PM �2�-S�, <br /> SITE ADDRESS PARCEL TAX I.D.p ERM!T# <br /> �1 '� � (Ai I� !'�� �'� 1� r�.l�l�. cd'���/'�/'U�� - <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDI/VISIO 11 /� }�{� <br /> DESC. i'�7J� ��I`��I�\�Y � 4i�`I�{� A�LI/I�O� <br /> OWNER ADDRESS CITV/IIP PHONE <br /> ��_�/�_1 � � f`t � ��I It�c 'U'�sf�;i� r• "2 ¢��o C�x3-3�1 L�IIEY�E_�T <br /> A Yt- � <br /> TENANT NAME CONTACT FO PERMIT ���0 ONE Q.,�� ��2.'L,��3 <br /> ;� � ���- �� ���>r�_. i.�+�-rNacrl e,'`r.:�r �1r�,�t fv�-�-a�� <br /> 1 Y'; �xzK�Y M Ac,� L.F��� <br /> - � <br /> �( t' I �/�U-t�r� s� n <br /> CONTR.LICENSEp ��'uI�CL �IS2QG ��-y���• / <br /> USE OF BUILDING HEAT SOURCE CONTRAt,T PRICE OF WORK <br /> � <br /> ����.>( ��(`.\�/ �i _Electric �Gas_Olhcr �D � D�C' �J <br /> WORK DESCRIPTION <br /> �� �� i � , �� y;, . �� ,, ;j�r" IM �Y�v� M���" <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF fl%TURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> — ������� A/C-air handlinc� unils <br /> --"�- p,j����i��� Forcr.d air systems <br /> Lavatory pvash basin) __ Gas piping <br /> - - Showr.r Walor heator <br /> Kilchen sink A disposal _ Gas lireplace <br /> Dishwasher Gas ranpc <br /> Clothes washer Clothas dryer <br /> Waten c�alor Rango hood <br /> Sink (servicelbadmopleta) _ Exhausl(an <br /> �ackllow proventm _ Hoal pump <br /> Urinal Unil heatm <br /> Drinking Fountain _ Boilor <br /> I — Floordrain = Relrigeration <br /> Grcase lrap Woods�ovo <br /> Rool drains Othor <br /> Other __ — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I herr.by cerildy Ihal I havo read and examineA this application and know Ihe same lo bo true and wrrect. All provisions of laws and <br /> ordinaces�oveming�his lypo of work will be complied wilh whe�hor spocified herein or no�.Tho granting of a permit does not presume <br /> t�,give aulhority lo violate or cancel Ihe provision of any olher slate or local law ropulating conslruction or Ihe pedurmance of <br /> iconsiruction. Tnat I am aulhori!�rd by�owner ot ihis property lo perlorm the work for which application is mode and I comply with the <br /> Stale Cuntradors Law 827 jQCW a d 962�0 WAC. <br /> �' , ,�. . // l ; �. � !/ - cz� �7 <br /> Si9na�urc ol Owner/Contiac�or/Aut iorized Ag�nt Dale <br /> ��� <br /> i ._ -- - —�- _ --- - <br /> __ . ..-- -----�-----.—� <br />