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PtRMIT APPLICATI(�N <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 /> AFPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D. # PERMIT 0 � <br /> ll � c, C-� , � ., .f- l; - �1�1 ��r�(p - �� <br /> LEGAL LOi NO. bLOCK TRACT OR SUB(11VISION p <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> ! / i, n( , �S F , _/1 JC� C. �• %i.e �fl�/- LLf,� `/ %:�5"���� 3 ��z ��- z /n - 73� ' <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> ��J �.. z >��7z �. <br /> l i / l�I',+ �i�4 r� E•MAIL <br /> �— __ _--�ibblfES�— �i:TT4R <br /> � � �.��/�. 5,,� /r 5 / .J�i ��' :'-G C / f�''� .�'r_ � � . �'. J <br /> } �ve�.�tf � 1r-: s� 7/ <br /> CONTR.LIC=NSF!I <br /> 9 �'.'� I <br /> USE OF BUILDING HEAT SOURCE CONTRACT PFICE OF WORK <br /> ��� � . — — � �� <br /> �% � /`-Eleclric Gas Other � '/�� �y � <br /> WORK DESCRIPTION <br /> �'�i i� / .� '�/ / /�'���,/?�!� <br /> !/ <br /> PLUMBING MECHANICAL <br /> I NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIl(TURE OR ITEM <br /> Toilel � NC- air handling unils <br /> BathWb _ Forced air syslems <br /> -- Lava�ory(wash basin) _ Gas pipin3 <br /> Shower Waler healer <br /> I Kitchen sink&dispusal _ Gas lireplace <br /> Dishwashcr Gasrang�� <br /> I� _ CIoUi_�s washer _ Clothes dryer <br /> W;�Icr healer Range hood <br /> � Sink(scrvi�eNarlmoplelc.) Exhausl fan <br /> � Backlluw preventer � Heal pump <br /> I Urinal _ Unit healer <br /> I Drinking Fountain _ Boiler <br /> � _ Floor drain __ Rofrigeralion <br /> Grense�rap _ Woodslove <br /> Roo(drains Other <br /> Other <br /> __ — <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS J105 <br /> iI hereby cerilily�hat I have read and examined this applir,ation and know Iho same to be true and correct. All provisions of laws and <br /> ordinaces�ovemin�Ihis type of work will be complied wilh whether specified horein or no�. The grantin�t of a permil does not prosume <br /> � to 9ive authority lo violato or cancul ihe provision ol any olh�r slale or local law regulating construclion or the performanco of <br /> � construction. That I am aulhorized by Ihe owner uf Ihis property lo peAorm Ihe work lor which applicaSon is mado and I comply wilh�he <br /> ' State Contraclors Law 18.27 RC\Y and 296200 WAC. ' <br /> I %'� �i/� " G - '�c'� vv <br /> / -� L l �G' <br /> ISiynaturo ol OwnedCon�ractodAuthonzed A9ont �ale <br /> I . . . . . . . . .------- ----- _ ._---------I <br />