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PERMI'r APPLIrATION <br /> ,� CITY OF EVERETT PEkt�71T .SERVICES <br /> 3200 CEDAR STREET, EVERE TT, VVA 98201 <br /> 425-257-8810 - FAX 425-257-8857 - www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# I PERMIT it � <br /> �y:'�? N� s;�u� ;— �� ���i7 < <�GY, � /�I� ' �3 <br /> C��� <br /> LEGAL LOT NO. � BLOCK , TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHUNE <br /> �dCnFT7� <br /> /�e�rc`/' (�c3�,<'cC .��1���'tl<`"�i✓c�T sr 9b��'� F/�5 ���i-5-�r'�'3 <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> �l y�� ��5 ��!L•�/ <br /> �(�/-f�1/ /��C'L.I/�� E•MAII <br /> �bFi�A�fib�._— —_ / <br /> p/7 r' d n��,�z� l�r��y�, . �H'R" �L.G/�l /��'/�r� �c�: [ ��N� ,���� �75 6 4�� �/ � <br /> CONTR.LICENSE N O��)'� <br /> D�y'Nr/'Fr9v���'c� -- ' — <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK I <br /> _Elec�ric �Gas___Other � _�"/�+�v� �'v <br /> WORK DESCRIPTION , � <br /> �flr�A�E FXi�;��� E�E�r�rie fr.�cN•�cE- tv�� N�w <br /> (f�`� i��a"'ni/rcE. N�' N`'rc' �f?5 !'ifin�C-� �E!'E �c5tn ?� tsl <br /> � /� �.,��; jiii�NAcl': Tf��i�'�-. <br /> PLUMBING MECHANICAL <br /> NO. I TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet FVC-air handling unils <br /> �alhtub T forced air syslems <br /> Laoatory(wash basin) _ Gas pipinc7 <br /> Showcr _ Waler healer <br /> Kilr.hcn sink 8 disposal _ Gas fireplaco <br /> Dishwasher __ Gasrange <br /> Clothes washer _ Clolhes dryer <br /> Walc�heatcr _ Ranyo hood <br /> Sink(servicelbadmopletc.) _ Exhaust fan <br /> Backllow piuveNer ___ Heat pump <br /> Urinal _ Unit hvater <br /> Drinking Fountain __ Boiler <br /> Floor drain ___ Relrigeralion <br /> Greasr,irap _ Woodslove <br /> - Rool drains Other_ <br /> Other — <br /> I - CITY OF EVERETT LOCAL SALES TAX CODE IS J705 _ <br /> iI hereby r.erili(y Qial I have read and examineA Ihis application and know�ho same�o`�e true and correcL All provisions of laws and <br /> ordinaces yoverNny this typo ol work will bu complied wilh whe0ier spocified herein or not.The grantin�of a pnr nil doos nol presume <br /> �! io �iv��aulhorily to violale or cancel lhe provision of any other state or local law regulating consWction or the per'ormance of <br /> �.onstruc6on. That I am aulhorizeA by�he owner o�this prope�ly lo perlorm Ihe work(or which application is mad� and 1 comply wilh tho <br /> Slal<�C9�jlrar.�ors Law 1�27 R aind 296200 W4C <br /> � <br /> j ,i � <br /> Si�nn ure OwnerlCont ' � .�rlA ������zed Agent Date <br /> t . . _ ._.. _ _ . .-- - �— ---------- ----- <br />