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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 �a -/ g -/(� <br /> SITE ADDRESS PARCEL TAX I.D.JI PERMIT# <br /> � � ��� < ��•�; �, �; � , �� c�� � —�;�;ti� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION M �/ � ,�`,� �/�� <br /> DESC. d <br /> OWNER ADDRESS CITYIZIP PHONE <br /> J�sr _<, 1�9L l°� i�� � ti�.tr�,�r s� E�e � � �- h� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> 1�, S ��'� V. � / E-MAIL /XU-�19tih4 UGCF� U.c- OU <br /> �SFITR7C�'r <br /> � —7��DRES`S`-- i.`TTYIt <br /> CONTR.LICENSE N ��. )�J'_�L�� <br /> N <br /> l8E OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> S � r` 1' Eleclric _Gas Y Other(,vy�„�� yo a�v <br /> �f' <br /> WORK DESCRIPTION �� �( �j <br /> � „�L ��,�s.� a�d: r��r✓� �s' � Z� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet _ A/C–ah handling unils <br /> �athtub _ Forced air systems <br /> �? Lavalory (wash basin) _ Gas piping <br /> _1_ Shower _ Water healer <br /> Kitchen sink 8 disposal _ Gas freplace <br /> Dishwasher _ Gas range <br /> Clolhes washer _ Clo�hes dryer <br /> Water heater _ Range hood <br /> Sink(servicelbar/mop/elc.) �. Exhaust(an <br /> CiackBow preventer _ Heat pump <br /> Urinal _ Unil healer <br /> Drinking Fountain _ �oilcr <br /> Floordrain _ Relrigeration , <br /> Grease lrap _ Woodstove i <br /> Rool drains -- ���1ef <br /> Olher _ — — <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3705 <br /> � I herc6y cerlily�hat I have read and examined this application and know Ihe same�o be�rue and correct. All provisions o(laws and <br /> ordinances goveming ihis type ol work will be complied wilh whether specified herein or noL The granting ot a permit does not presume <br /> to gwe authority to violate or cancel Ihe provision ol any other state or local law regitlaling consiruction or the peAormance of <br /> construclion. That I am authonzed,by ihe owner of Ihis propeAy to peAorm the work for which application is made end I wmply with ihe <br /> Slate Co tractors Law 1827 R and 296.200 WAC. <br /> ���� �,:' ���� ' /6�//- l � <br /> Signalure of OwnedConiractodAuthorited Agent �ate (/ <br /> � <br />