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� <br /> PERMIT APPLICA.TION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 32U0 CEDAR STREET EVERETT, WA 98201 <br /> 425-257-8870- FAX 425-25l-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS il y S-Z i S PARCEL TAX I.D.p PER�# <br /> jC�O�j 1�.1 C`[� Si.�i,(��� 2 `��4 � c�0.'� It)D2.OL� .�0 �/� ��3 <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION p <br /> �ES�.J <br /> OWNER ADDRESS CIN21P PHONE <br /> �j ' � �e��C I..J1�} <br /> Ut'�vlLS � l � <br /> TENANT NAM CONTACT FOR PERMIT PHONE 40� L E.1� <br /> -f 2�� <br /> ��c3ATk�CT6k� ��C� __ �f�S •J Dh T ri i�N ��e�rna� <br /> fl1(!� hn��, .l�l M��le( -7"�� '1 Ort✓u�k (1v.a `ia�N�� �1.412�� 2u ! <br /> CONTR.LICENSE N n�I� � Do F� �.,�� �, Il.�i �l- 3-`i 4 on <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> y�`�Eleclrir. ___ 3as__Othcr <br /> WORKDESCRIPTION \�� `,{ril\ �Y1c'cl��q„�,r ��1 ��- 1�1��..-b„�c� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A�C-air handling units <br /> - p�������� Forcod air syslems <br /> 3 Lavalory(wash b: :in) Gas piping <br /> Shower _� Walerhealer <br /> Kitchen sink&disposnl _ Gas lireplace <br /> Dishwasher _ _ Gas range <br /> Clothes washc�r Clolhes dryer <br /> % Walen c�ater Ranc�e hood <br /> 1 Sink(servicelbadmoµ'etr..) 2. Exhausl(an <br /> __ Backflow preventer _� Heat pump <br /> � Urinal _ Unit healer I <br /> � _1._ Dnnkiny Fountain _ Boiler <br /> ' Floor drain Refrigeralion <br /> Grease lrap _ Woodstove � <br /> Roo�drains _ Olhor_ I <br /> � Olher 4 4'�'f�- ��..��.�� -- <br /> .. ---1--���i„<<, ��e S1. -' — ' <br /> ��r—.- ,, <br /> CITY OF EVERETT IOCAL SALES TAX CODE IS 7705 <br /> I hereby cerilily thal I have reeA and examined this application and know tho sam��o be lruo and correc�. All provisions ol laws and <br /> ��rd�naces�overnin9 Ihis typc of work will be complied wilh whe�her spocified herein or noL 1 he granting of a permil does nol presume <br /> to yiv�au0iority lo violate or cancel Ihe provision ol any olher state or local law rec�ulating consWclion o�lhe porformance of <br /> r.onsirur,tion. Thal I am�uUiorizad by Uie owner ol Ihis property to perlorm�he work lor which applicalion is made and I com,ly wtlh ihe <br /> Stale Conlrar.�urs Law 1A.':7 RCW nnd 296200 WAC. <br /> �'�'� ti,- 1 ' �- 5/iolC6� , <br /> Sic�na re�of OwnedContrador/Authorized Agenl Dale <br /> I <br /> � _ _ __— __ __ <br />