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PERMIT Al�PLICATIUN <br /> CITY OF EVERETT �'[=RMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAY. 425-257-8057 —www.evereltwa.org <br /> APPLICATIONS ARE ACCEPTED FROf�7 8 AM TO 4 PM <br /> SITE ADDRESS -`� r��-�' ����' PARCEL TAX I.D.# PERMIT p <br /> � ii � <br /> �� ��� �il� �n�7 ,S//�!� /'-�U' �{�)� ��� , .ct�t.�5 U� U <br /> IEGAL LOT NO. BLOCK TRACT OR SUBDIVISION M <br /> DFSC. <br /> OWNER ADDRESS CITYIZIP PMONE <br /> '/���� � � � _ — n ' <br /> TENANT NAM�F CONTACT FOR PL'RMIT PHONE�, /Z} (�7E� `(N <br /> � (�?�aKS / Y ��t � <br /> ��F- � � �C� �-���J/��� � �- ��MAIL <br /> � �� (-yZ�� ir.li� c,��is !„_ ,�< 'T� ��1, 9� 'ZS" '�-�' �n,.c�, �'R: `���OX ��C'};�7� 9! � -� <br /> CONTR��pjj.LICENSE M � `r ?� <br /> �I��;1 �.��/J O�"I �V <br /> USE OF BUIL�ING HEAT SOURCE CONTRACT PRICE Of WGRK <br /> e,�-y,�r (-�N C� _Electric __Gas_Olhor �-� (n �I�J <br /> WORK DESCRIPTION <br /> �,��5�,-�rti L?c,�, :,T i=� n Ic C� or✓ F[�r c�t.-C�,✓c� <br /> PLUMBING MECHlaNICAL <br /> N0. TYPE OF FI%TURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet A/C-air handling unils <br /> Bathlub _ Forced air sys�ems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water hoater <br /> Kilchen sink 8 disposal _ Gas lireplaca <br /> Dishwashor _ Gasrangc <br /> Clolhes washer Clo�hos drycr <br /> Walcr hoater Ranc�o hood <br /> Sink(service%badmop�etc.) _ Exhaust fan <br /> [�ackflow preventer _ Hoat pump <br /> Urinal Unit hoaler <br /> Drinkinc� Fountain _ Bolle� <br /> Floor drain Refrigaration <br /> Grease Irap _ Woodslove <br /> Roof drains Other__ <br /> Other <br /> CITY OF EVEREIT LOCAL SALES T/V(GODE IS 9105 <br /> I hereby ceritify that I have read and oxamined Ihis application anA know Ihe same lo bo true and correcL All provisions of laws and <br /> ordinaces governing this type ol work will be complied wilh whother specifiod heroin or nol.The granting of a permit does not presume <br /> to�ive aulhorily lo violate or cancel the provision of any other slalo or local law rugulaling consWction or the perlormance of <br /> consiruclion. That I am au�horizod by the ownor of this property lo peAorm the work for which applicalion is made and I comply wilh the <br /> Slal onlractors Law�1 7 RCW anA 6.2001NAC. <br /> ;�_..•,,��_� (�.-�p,,./�� � 3 � � , <br /> Sionature o(OwnedContraclor/Authorized Agont Date .� <br />