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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM P�tJ �:Oa-,) Y <br /> SITE ADD�RESS PARCEL TAX I.D.# P RMIT p <br /> Z3 ��.� �cO���R 5T. C>0 �" H UO"Lo13oU �� �- 3j <br /> LEGAI LOTNO. BLOCK TRACT <br /> oEs�. ► 3 �1y 2- oia �o Aop. iz� E �crt � TT <br /> OWNER ADDRESS CITYIZIP PHONE <br /> I�f�Ad� (�5. NomEs 3�1�,�, �,�tbqv�,. 1�E tucRe�'� ,9$205 �125-3�'j�-�3b� <br /> TENANT NAME I CONTACi FOR PERMIT PHONE <br /> CONTRACTUR ADDRESS CITYIZIP PHONE <br /> iar��ck aRcs. ►�Mrs �122 �,���q� N,E f�cQc;� q�,zos tias� 39 �-73E�o <br /> CONTR.LICENSE N <br /> ���CK 13'L V 1 Z�Z <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> 5��� _[Icclric �Gas_O�her �3� I\ <br /> WORK DESCRIPTION <br /> /(l�w sf� RAs�c �- /�'� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FI%TURE OR ITEI,I NO. TVPE OF FIXTURE OR�TEM <br /> �3 Toilel A/C-air handling unils <br /> � p�p����� � Forced air systems <br /> �_ Lavalory(wash basin) � Gas piping <br /> 1_ Shower � Water healer <br /> � Ki�chen sink 8 disposnl � Gas fireplace <br /> L Dishwashor 1— Gasrange <br /> � Clolhes washer _� Guthes dryer <br /> `�' Walcn c�ater 1 Range hooA <br /> Sink (sorvi.:c/barlmoplelc.) � Fxhausl lan <br /> Oackflow prevenler _ Heat�;ump <br /> Urinal Unil heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease tra�� Woodslove <br /> Roaf drains O�her <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hem6y ceritily Oiat I havo road and examined Ihis apphcalion and know the same�o be irue and c:orrecl. All provisions of laws and <br /> ordinacos governing Ihis lype ol work will bo complied wilh whelher specifiod herein or noL The granling ol a permil does not presume <br /> to yive authority lo violato or cancel ihe provision ot any other slate or local law regulatinp construclion or the peAormance ot <br /> construclion That 1 am�ulhoriz d by Ihe owner of this property lo peAorm ihe work lor which application Is mada and I compty with the <br /> St �n�r. :1 r Law i .2 R anA 29u.20U WAC. ` /1 <br /> ^ `/ V� <br /> Sic��atur ol edCon ra t /Aul orized A�onl Date <br /> � <br /> %z <br /> _ _ , _ _ _ -- -- - — <br />