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I <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES ' <br /> 3200 CEDAR STREET, EVERETT, WA 98201 I <br /> 425-257-8810 - FAX 425-257-8857 - www.evereuwa.org �_as i'I <br /> // - 3 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE AODRESS � PARCEL TAX I.D.t! PERMIT# ' <br /> � ` l �l Llllc�- ���i���- �-'i -t - ,�L� l��—�j <br /> L[GAL LOT N0. BLOCK TRACT <br /> ocsc L � �% <br /> OWNER ' ADORESS CITY2IP PMONE <br /> ! <br /> Ly���1 ��SSIc I �SQitit�� Ll�'Yi' ff" �%.1'�u� y�� —��5��—�?`i`� <br /> tENA T NP'AE CONTALi FOR PENMIT PHONE <br /> CONTRACTOR�-I���L.�� ���'Vi< <S r�, AODRESS��'���L� ��� Sj���.ki ��TY/ZIP PHONE <br /> I Q� / / 1 {� 1 / ' <br /> CONTR. LICENSEM ""r' Vlll I �+ � ' I ��� ��� �� ��-� �'�I V� II <br /> 11�UGU�S I l y9N� �,��,�� - <br /> USE OF BUIIDING HEAT SOURCE CONTRACT PRICE OF WORK ' <br /> S ,F (� I _Electnc �., Gas _ Other <br /> ,� <br /> WORK DESCRIPTION <br /> Iii���tl �- � (1.1i1� 1�,��'�', uli'-�-�1.�� �.���� � � �>C'r`�L <br /> ��F 1��11��t/ 1�7 u`�( l, , �� <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FI%TURE OR ITEM NO. I TYPE OF FUlTURE OR ITEM �� <br /> Todcl NC-2ir hand6ng units <br /> d�����ii�� ( Forced atr systoms <br /> Lavatory(wash basin) H Gas piping <br /> Shower � Waler heater . <br /> Kitchen sink R dispus;il Gas Iveplace � <br /> D�shwashcr Gasrange <br /> Clothes washer Clo�hes dryor � <br /> Laundry Uay Range hood � <br /> Sink�seNicclhadniu�vuic 1 Exhaust fan <br /> Backllow l�rr.venter Heat Pump <br /> ���i��i Und hc�ter <br /> Drinking Fountain Boiler <br /> Floor d�am Refrigeration <br /> Grease trap Woodstove <br /> Rool Ar�ins Othcr . -_-___ . , <br /> O�hm _. _ _.___ '. <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J705 � <br /> I hereby cr,nlAy ihat I have read and examined ihis�pplication and know the same to be tiue and correcl. All provisions ol laws and ��i <br /> ordmaces yovcrning this type ol work will be comphed with whelher specdied herein or not. The granting ol� permil does not presume I <br /> to grve authordy to violate or cancel the prowsion of any olher slala or Iecal law regulaliny consiruclion or Ihe pertormanco ol <br /> ��.onstruction That I am nuthor¢ed by the ownor ol this property to perfonn!he work lor which application is mado anA I comply with Ihe I <br /> St�l�C Irac�ors Law 1P?�7 RCW and 296200 WAC <br /> > ? . <br /> ��� � , �z (� �.,� I l ��� 05 ��� <br />� I Siqn.it�i o nl wnr.rlConlrAr,tor/Authon7eA�pen� Da�e <br />