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� _ <br /> ------- — - ----- � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-8810–FAX 425-257-8857–www.everettwa.org �`i9"�� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM " '�IOO7_D� <br /> SITE ADDRESS PARCEL TAX I.D.tl PERMI7# <br /> ��5 . <<s J. � ,oo� �01 <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION p <br /> DESC. <br /> OWNER ADDRE�G CITYIZIP PHONE <br /> /�ch �c.l-��-✓� Lol•- 79o-osFf <br /> l�d• X$o �C Z S6 3 K• �la/�,,J, 9vo Sr3 <br /> TENANT NAME CONTACT FOR PERMIT PHONE ��d _ y39-�3 7 <br /> I /�I[./' G�� r'-^ E•MAIL <br /> A�iL W�rs �:r CIln;^✓) Z�V�O f �6�It�� 3�0 -959 �.6> > <br /> CONTR.LICBNSEM � S�^wc�� <br /> k�IW.�.� c �7yc3 S•�, -I�- 9Vt9Z <br /> USE OF BUILDING I FiEAT SOURCE CONTRACT PRICE OF WORK <br /> T n�` $���� �, _Electric �Gas_Olher � S5 7S 00 <br /> I.C. <br /> WORK DESCRIPTION �U� ` 3 ��.N 5 <br /> — PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toitet A/C—air handling units <br /> Dathtub � forced air systems <br /> lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink R disposal _ Gas fireplace <br /> Dishwasher _ Gasrange <br /> Clothes washer Clo�hes dryer <br /> Water healer Range hood <br /> Sink(service/badmop/e�c.) _ Exhaust fan <br /> 13ack11ow prevenler __ Heal pump <br /> Urinul Unit heater <br /> Drinkin�Poun�ain _ �oiler <br /> � f=loor drain _ Refrigeralion <br /> Grease Irap _ Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J106 <br /> I hereby certily thal I have read and examined this applicetion end know the same lo be Irue and cxrect. All provisions ol laws and <br /> ordinances goveming Ihis typo of work wil�ba complied with whether specified herein or not The granting ol a permit does not presume <br /> lo gwe aidhority lo vidata or cancel Ihe provision of any other s�a�e or local law regu�ating consWction or the perTormance o/ <br /> cmislruclioa Thal I am authonzed by the owner ol this property to perform the work Ior which epplication is made and I comply with the <br /> Slate Coniractors Law 18.27 RCW and 298200 WAC. <br /> � „ 7-/9-/O <br /> 5' nature of Own /Coniractor/Aulhorized Agenl Date <br />