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l <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT.WA 98201 <br /> 425•257-8810- FAX 425-257-8857-www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � �-g-E�� <br /> SITE ADORESS Cf�, _. PARCEL TAX I.D.N P,g M��T� <br /> �i n�UT � ooy C� 7/ - <br /> LEGA LOT N0. BLOCK 7RACT OR SUBDIVISION/ � � <br /> oesc. _ Z� � .2 .2� EVE�/%Sv��7�viSioN 'o <br /> OWNER ADDRE95 CITYlLP PHONE <br /> n C �)sy.s-a��y <br /> �f,V�c/✓ �l�NCTS �/.S/R✓CTio�cl /S// /lJ.SSE�i�SEA%/LEG/�i4 gg/03 <br /> TENANT NM1E I CONT LFOR PE . PNONE �Z�-Z�j�1-`i'Z n-� <br /> I M�1"'>>i�,..��-,�C�r. <br /> Irh�;c�'��u�icJ�25i c,n L� <br /> c ir.��. I� �'�. E*IAIL N•+-� n.c., <br /> ,4v&N �v�n�G S C:an�u�.-�xrti' � Sii �J SS�S i �R�tlE�s+o3 a�c� 53'S-zd`J <br /> CONTR.LICENSE 1 <br /> USE OF BU�LDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> O _ 2 _Eleclric �as /� Olher <br /> /1 J <br /> WORK DESCRIPTION ��� pj AS � e- 3�� <br /> �J N �� i � <br /> � � - <br /> F'LUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilel AIC-air handling unils <br /> Bathtub Forcad air systems <br /> Lavatory(wash basin) � Gas piping <br /> Shower Waler heater <br /> � Kilchon sink 8�isposal Z Gas fireplace <br /> Dishwashor Gasrange <br /> � Clolhes washor � Clothes dryer <br /> � Water healor Range faod <br /> Sink(servicelbar/mop/elc.) � Exhausltan <br /> BackOow prevonler _ Heal pump <br /> Urinal Unil heater <br /> _ Drtnking Founlain Boiler <br /> _ Floordrafn � Refrigera6on <br /> Grease lrep _ Woadstove <br /> Rool drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS�105 <br /> I hereby ceri6y that I havo road and examinod lhis epplicalion and know lho same lo be Wo and cortect. !UI provisions ot laws and <br /> ordinacos goveming lhis typo ol work will ba compliod wilh whether specifled hereln or not.The granling o(a permil doea nol presume <br /> lo givo aulhorily lo violato ar cancol Iho provlsion of any olher stele or bcal law regulatlng constructlon or the pertortnance of <br /> conslruclion.That I am aulho�ized by the owner ol Ihis property lo peAortn the work lor which applicalion fa mado and I comply wilh Ihe <br /> `Slate�Contraclors La 1827 RCW and 29G.200 WAC. <br /> 7 /%-09_ U7 <br /> �/�Sig a uro of odConlraclor ri�ed�gent Date I/ <br /> Z <br /> � _ <br />