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FERMIT APPLICATIt�I� � <br /> CITY OF EVERETT PERMIT SERVlCES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � Z `-D ,3 --0� <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � �1/I ��Z� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMITjI <br /> � ,�r, ��J Clkl►Jo I:D E�1�sc � ���/� �// <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIYISION M <br /> DESC. <br /> OWNER ADDRESS CITVIZIP PHONE <br /> DKS Eoa� M��.r-r 51ou c.As►��� ►� ev���� Q8�1 4'-`�-�� - ui� <br /> TENANT NAME CONTACT FOR PEnMiT PHONE ��_ 2�J�—�0�I <br /> �J <br /> ���✓�. ���.Y�IL E•MAIL <br /> f�11 k� 5 Iu��N S ib n� S �-� 11; lo�,rl, s r sL 'Ev�lzzi7 �+�i-�So-�d''-� <br /> CONTR.LICENSE p <br /> USE OF BUILDING HEAT SOURCE CONTRACT FRICE OF WORK <br /> � <br /> _Eleclric __Gas_Olher # �j I.UU <br /> WORK DESCRIPTION <br /> I�uM „v �+-rzu 511�c-� ML1�► � pa..b� E �Fti�� SiU �J <br /> �r�. �ti� S�t,+ P��� PosT . <br /> PLUMBING MECHANICAL <br /> NG. TYPE OF FIXTURE OR 11EM NO. TVPE OF FI%TURE OR ITEh7 <br /> Toilet A/C-air handling unils <br /> Dathtub ForceA air systems <br /> Lavalory(wash basin) _ Gas piping �� �� <br /> Shower Water healor <br /> Kitchen sink 8 disposal _ Gas fireplace ��,�. l, <br /> Dishwashcr _ Gas ranya <br /> Clolhes washer _ Clolhes dryer % ` ' <br /> Water heater , Ranc�e hood � <br /> Sink(sorvicelbarhnopleic.) _ Exhaust(an -- — "--- - ,_ <br /> �ack0ow preventcr _ Heat pump � <br /> Urinal _ Und heator � <br /> Drinking Fountam __ Boiler � '1 <br /> Floor drain __ Refngeralion r ; <br /> Greasr.lrap WoodKtove i <br /> _ Rool drains _ Olhetf � ;"� <br /> Other--- ---- -- _— 't— /1f � <br /> -- - - - ----- <br /> ---- ----__----- — � v- . "� <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 910: <br /> ' �.....__.___ _..._ <br /> I herehy ceritily that I have read and evamined Ihis applicalion anJ know tha same lo bo lrue and corfecl All provisions o(laws and <br /> ordi�iaces yoverning lhis type of�vork will be complied wilh whelher specilied herein or noL The grantiny ol a pormil does no�presume <br /> to give aulhorily to violalo or canccl the provision of any other stale or loc�l law regu�aling conshuclion or ihe podormance ol I <br /> construr.lion.Thal I am aulhorized by the owner of lhis property to perform the work for which application is made and I comply wilh Ihe <br /> State Coniract rs Law 1827 RCW and 296.200 WAC. <br /> I �' Li �'l/ `J.. �--�� � // Z J <br /> Signature f O edConlracto /Authorized Ac�ent Da�e <br /> I . _ . __ . �ly <br />