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-- -- ---- --- -- �- <br /> P�RMIT A�PLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> I 3200 CEDAR STREET, EVERETT, WA 98201 <br /> � 425-257�88?0 – fAX 425-257-8857 –w��vw.everettwa.org <br /> � APPLICATIONS ARF ACCEPTED FROM 8 AM TO 4 PM <br /> ISITE ADDRESS 95 Z� ' PARCEL TAX I.D.p PERMIT k <br /> �,���� 5 << S �i c .��s����i 2 n _ <br /> r%Q�G'1 -O!/ <br /> LEGAL LOT NC. BLOCK TRACT OR SUBDIVISION p <br /> DESC. <br /> OWNFR ADDkESS CIN21P PHONE <br /> t,,_'C I ll,��) <br /> TENANT NAME I CONTACT FOR PERMIT PHONE �%1� 7/ � /7�/Z <br /> .��i� y�lkl ���5%l/1�1D7�-' e-nnni� i L,.hasl�inr�d,�'_b�,�•� ,� ,ti� <br /> —A66RE�s � <br /> ln��V ����iuml� Nndt7t'uc71JM CJM/An.y /�l/4, � q/'(C {6�q _ <br /> CONTN.LICENSEM ��1�>S" i�'"�Av2� S�x�7�1 ��KI J� r',�(;- �C-1 -`I/IS <br /> �v1��y�1fC I';l'MW <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> , �, '� i✓ ',��� � I l r, � Electric _Gas __Othor y'Z�Sj SJ`� <br /> WORK DESCRIPTION <br /> ��..•r�S;/.'u��i �1u•.� C �'C,�` Sry'. � R'C <br /> PLUMBING MECHANICAL <br /> NO. TYPF OF FIXTURE OR ITEM NO. I TYPC OF FIXTURE OR ITEM <br /> Toilel FVC-air hnndlinc�units <br /> �alhWb _ Forcedairsystems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Water healer <br /> Kilchen sink 8 disposal _ Gas lireplace <br /> Dishwasher Gas range <br /> Clothr.s washer Cblhes dryer <br /> Walen c�aler Range hood <br /> Sink (servicelbadmuplelc.) _ Exhausl lan <br /> Dackflow prevenler _ Heal pump <br /> Urinal _ l�n�t hoater <br /> Drinking Founlain _ Boilor <br /> Floor drain Re(rigeration <br /> Groase trap _ Woodstove <br /> Rool dr�ins _ O�her <br /> Olher---------- — <br /> � --- __ — <br /> � <br /> iCITV OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I1 hereby ceritily Ihal I havc read and examined Ihis appfication and know�ho same to be true and correcL All provisions of laws and <br /> I urdinar,es govrrning Ihis�ype o(work will be complied wilh whother specilied herein or noL The 9ranting of a permil does not presume <br /> 'I to yivr,aulhorily lo viNale or cancel tho provisiun of any olher slale or local law regulating consWc�ion or lhe pedormance of <br /> cunstruction.That I am aulhorized by�he owner of ihis property lo per(orm the work lor which application is made and I comply wilh Iho <br /> iSla�e Conlractors Law 1827 RCW and 296.200 WAC. <br /> � � �i. ��il�i.iltl'-�r ,/ �.�l., � � <br /> ! Siyn ture of OwnedCuniracludAuthoriz�d Agent Date �Z <br />