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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR S?REET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857 —www.everettwa.org <br /> APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �(� (�S��U <br /> SITE ADDRESS PARCEL TAX I.D.p PERMIT# <br /> :.0 lC 4/. G�li//./C �i"G' iYL,'.O�/���L°.- I['C� �) � '� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION p <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE n��,���ai <br /> �11L �rf.qs ,b <br /> VC�Li:c.�/ ?Zc��' A�•<i✓:.O !:1 , �4G:dr1�JOiv7lr i O4�Y A„�rr,:� 7fi�� 1fPy _ <br /> TENANT NAME CONTAr,T FOR PERMIT PHONE ./�y- x,-O -Pj(.fi <br /> K�'�v a�'u���r/o�e,i,ra_<.� <br /> E-MAIL R�SK�tifd�MSN, t.�J <br /> �AfkA�Ybfi-- � <br /> SA/iSiL L�%�/S77�ilf�Ci✓ �f5-�- � L;.(� iN j•� i71�C�:�J� N/4 "^�(�� z5J '�1�- ^i�� <br /> CONTR.LICENSEp.Y;�• f�f�.�;� �IL.�.33L� <br /> USE OF BUILDING � HEAT SOURCE CONTRACT PRICE OF WORK <br /> �N�`'�''� � �U`" �s`"�'`!V Electric Gas_OU�9r <br /> WORK DESCRIPTION <br /> LYri��' /rJFt� /�C.1✓1J fI Cda/Q/�/ <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM 1•J. TYPE OF FI%TURE OR ITEM <br /> Toilel _ A�C-air handling units <br /> Oa�hlub Forced �ar syslems <br /> lavalory(wash basin) _ Gas piping <br /> Showr,r Water hoaler <br /> Kitchen sink 8 disposal _ Gas lireplaco <br /> Dishwasher Gas rango <br /> Cblhes washcr Clolhes dryer <br /> Water healer Range hood <br /> Sink (sercicelbadmop/etc.) Ezhaust lan <br /> Backflow prevenler _ Hea�pump I <br /> Urinal Unit hoater <br /> Drinking Founlain _ Boilor <br /> Floor drain Relrigaralion <br /> Greaso irap _ Woodstove <br /> Roof drains O�her <br /> Olher <br /> CITY OF EVERETT IOCAL SALES TAX CODE IS J105 <br /> I hereby corilify�ha�I have re�d and ezamined�his applicalion and knew iho same�o be Iruo and correct. All provisions ot laws and <br /> orJin2ces yoverning this lype ol work will be complleA wilh whether specilied herein or noL The granling ol a permil does nol presume <br /> to yive aulhurity to viulale or cancel the provision ol any other state or local iaw rogulaling consiruc�ion or iho perlormancn ol <br /> conslruclion. That I am aulhorized by the owner ol this property lo perlorm�he work lor which application is made and I comply wilh lhe <br /> Stale Contrar.tors Law iB.27 RCW and 2�J620D WAC. <br /> � <br /> I � - <br /> ��.�� e,rY.--�� '< i)/��� <br /> Si�nalure of OwnedContraclodAuthorized A�enl f Dato <br /> __I <br />