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PERMIT APPLIC�ITION <br /> CITY OF EVERETT PERMIT SER`�ICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> �ZI_C�� APPUCATIONS ARE ACCEPTED FROM B AM TO 4 PM _ <br /> SITE ADDRESS PARCEL TAX I.D.N PERMIT p <br /> k1EssC U.�Uo 0 2�0�1 l'��2�4�� � c,-�tn�- l�I � <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> WNER ADDRESS CITV2IP PM NE <br /> A�Jq�t-cw� pEv�4�,�ME� lCo`iar� �tFKwfE-R SEO�t'ClF_/ 'LcY�'Lurtj•c�s5S <br /> G.�MPtw� �tZkklAY,��'CE Sd2 �l�(� <br /> TENANTNAME CONTACTFORPERMIT PHONE ��'b"IB��_ <br /> --'_' i�'�N L�-�.^K` ol�h. �14C��n0.�' <br /> E•Ma� ��(rthRfSPc .co..,., <br /> AN��t'S�JCTicN WG���Eb�RF ��cY�rtER �,,,1,�.� (_ / <br /> �'o �1 o�n ' "''=l �C(o-8?�.3�0 <br /> CONTR.LICENSE/27A���-G� cl��� I��k k(b,Y� ��TE- S�`2. �j(�� <br /> \ <br /> USE OF BUILDINr HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��/� ` ��-� _Elettiic l�Gas__Olher ��'1S� .�� <br /> WORK DESCRIPTION <br /> N.'Ek! l�, 21l SP "�ll-'�- �'���1 rz- <br /> le��s-t�� ���ou.�CG <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FlXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet _ NC-air handling units <br /> Bathlub Forced air syslems <br /> Lavatory(wash basin� __ Gas piping <br /> -� Shower __ Waterheater <br /> � Kitchen sink 8 Aisposnl _ Gas lireplace <br /> Dishwasher ___ Gas range <br /> Clothes washer __ Clothes dryer <br /> Water heater ___ Range hood <br /> Sink(serviceNaNmop'etc ) ___ Exhaust lan <br /> Backllow provemer __ _ Heat pump <br /> Winal __ Unit hea�er <br /> Drinking Foun�ain __,__ Poilar <br /> Floor drain . Relrigeration <br /> Gioase trap __ Woalstove <br /> � Rool drains Uther _ ,. <br /> ._.. OIhP.f _-_� .—--_ _—-- ____' <br /> CITV OF EVERER LOCAL SALES TAX CODE IS�105 <br /> I hereby ceritily Ihat I have read anA exam�ned Uiis application antl know the same lo be irue and correct. All provisions ol laws and <br /> ordmaces goveming Ihis rype ol work will be comp�ied with wheUier specilied herein or noL The gran�ing ol a permit does no�piesume <br /> to give aulhority lo violate or cancel the provision ol any olher=.ta�e or local law regulating cons�mction oi ihe pedormance ol <br /> consiruction. Thal I am aulhonred by Uie owner ol Ihis property to pedorm ihe wnrh lor which application is made and I comply with Ihe <br /> Slal Contraclors Law g.�7 RCW and.296200 WAC. <br /> � ' � 2/iS l�v <br /> S�qna ure o�Ownea onlraclodAuthwiled Aqen� Date I <br /> � <br /> L <br />