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PtRMIT APPLICATIC�nI <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 �—aD —O� <br /> SITE%��ESS � c� � � PARCEL TAX I.D.# �\/\�C�G,a - c�y <br /> LEGAL LOT N0. BLOCK TRACT OR SUBOIVISION k <br /> �ESC. <br /> OWNER ADDRESS CITV2IP PMONE <br /> Ja�.:F M�r�� �L `�'7i�3 c��v� �vt�r 7�sn - ���5 <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> �,��b 4•.J /JD/�-la7QY'1 � E-MAIL y� �SSS'ycZ',9 <br /> �bAT�A <br /> N��.',�sr�'��r� �a,:.�n-„H. r� ,�,K� y7� 7 53�'''"'.wc Ne MR,eysv,c�, wA <br /> CONTR. LICENSE H <br /> rv�/'vs,yr� 97S/'�s Y'�Z.7o y'zs'3�5"' Yoc�9 <br /> USE OF BUILDING -� — HEAT SOURCE CONTRACT PRICE OF WORK <br /> 6�' <br /> �/,n�. Eleclric Gas_Olhcr �s� S �,� �— <br /> 7 ° <br /> WORK OESCRIPTION <br /> �t:f��i�'t= �U.CNR-1_ 4. ,Si;/"E �4GT l.a.l�,tK <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIxTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilr,l A/C-air handling units <br /> Dalhtub � forced air systoms <br /> Lavatory(wash basin) _ Gas piping <br /> Showcr Watcn c�aler <br /> Kitchen sink 8 disposal Gas fireplaco <br /> Dishwasher Gasrange <br /> i — Clothes washer = Clothes dryer <br /> Waler healer Rangc hood <br /> Sink(service/badmop/etc.) _ Exhausl fan <br /> Backllow preventer Heal pump <br /> Urinal Unit heator <br /> � Drinkinc� Fountain _ Boiler <br /> Floor drain Relrigeralion <br /> Grcaso Irap Woodstove <br /> Rool drains Olhar <br /> Olher <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby cerilify iha�I have read and examined�his applicalion and know ihe samo lo be�rue and correcl. All provisions ol laws and <br /> ordinaces�overninc�this type ul work will bo complied with whether speci(ied heroin or noL The granting o(a permil does not presume <br /> tu yivo authority to violate nr cancol ihe provision ol any other slate or local law regulating consiruction or lha peAormance of <br /> construc6on.That I am authorized by the owner ol this properly lo pedorm ihe work for which applicalion is made and I comply wilh lhe <br /> •� Slale Conlraclors Law 1ti.27 RCW anA 2�6.200 WAC. <br /> ' - � � ' _� �� � -_ Z Zo a9 <br /> � Signature ol wnerlConlraclorlAull�Ac�en� Dalo � <br /> II . . _ _ __....__ _- ------------- - <br />