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P�RMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 99201 <br /> 425-257-8810 -- FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM L� � 3� �� <br /> SITE ADDRESS PARCEL TAX I.D. p P RMIT <br /> � �!P 311s' - „ ' <br /> , 7 <br /> I�1.L�" . 0�l ':ir��� 7 f�cv-�t� � . r � •�f 7 .��./�f.7_ J ' � <br /> IEGAL LOTNO. BLOCK TRACTORSUBDIVISIONN i?i>�: .?� �� !'E>.�'��^�J <br /> oesc J �-i`�'�- r � �,a D,a - ;�{ -� c��. y,�i�. / <br /> OWNER AODRESS CITY2IP PHONE <br /> � t'., �" � ".��. v A.1/!�:�.;�.��\, /.',.,; ! .<"i'ii/�.'� . ...� �7.;i.'C I�� `7,S"1��j <br /> TENANT NAME � CONTACT FOR PERMIT PHONE <br /> � ��lr�,lyc;., s ,�5 <br /> ( �) .'� `�� �... � Al,'(//�z '�ni /ii � � � ii�:ir rJ�� <br /> E•MAIL�illY._✓.r�l.N(�ti�'77r.1'. '�:�- <br /> �i)� .� ia� i ��ll�'� �'rl):a���l. ' J� � /�''lfY1 /�/[ l�(ISCi('!/ (/�K4 / �J ' )'%' l%; <br /> CONTR.LICENSE p '�;i��c, �, �)I C, � „�,�. .:N��4n.,��:i�' . .� <br /> -�,—,,�,��,,y�..tw:-, :.� ✓ �,��� s��.> ,�- <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> • , f-- - Eleclric Gas Other ��C'� �" ��" <br /> i � � — — — <br /> WORKDESCRIPTIONi�r',�l���rli�j- ��i�i:�',.'. 'r ��,r� ✓�°�cri'T- -C� r� l�l�:•.�,✓� ; .•�l'7 -s�-- <br /> ��q i�Q LN E�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TVPE OF fIXTURE OR ITEM <br /> Toilr.t A/C-air handling unils <br /> Ba1Mub _ Forr.ed air syslems <br /> l.avalory (wash basin) -- Gas piping <br /> �--- Shawer ___ Walcnc�ator <br /> Kilchen sink 8 dis��sal _ 3as lireplace <br /> Dishwasher _ Gas range <br /> Golhes washer _ Clothes dryor <br /> Watrr hr.aler _ Ranc�e hood <br /> Sink�sr,rvice/barhnopletc.) __ Exhausllan <br /> Backllow preventer __ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain __ Boiler <br /> Floordrain __ Relrigeralion <br /> Grease trap _ Woodstove <br /> Rool dr2ins O�hor <br /> Olhcr — <br /> CITY OF EVERET7 LOCAL SALES TA7(CODE IS 3105 <br /> I hr.reby cori�ily Ihat I have rFnd and examined Ihis application and know Ihe same to be true and correcl. All provisions ol laws and <br /> ordinaces governiny Ihis lype o�work will be complied with whether specilied heroin or not.The granling of a permit does not presume <br /> b yive auUiority to violate or canyei Ihe provision o�any olher state or local law regula�ing conslruclion or iho podormance of <br /> � r.onstruction. Niat I am authori�Ld by the owner ol Ihis property lo peAorm Ihe work tor which applic2tion is made and I comply wilh�he <br /> State Contraf:lors Law 7y.?.IRCW anA 29f2O0 WAC. <br /> I . � <br /> / �� ( c-• ,��i� �1��i <br /> � Signalure o�Ownorl onlr2 IndAidhorizod A9ent Date � <br /> 1 ��Z/ <br /> ' � <br /> _ _ _- - — -- ------------ — ---� <br /> ,_ - <br />