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_ - ; <br /> PERIVi�T 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 <br /> ��-nv �. � 2 _ <br /> SITE AUDRESS yJ �f I L 7, PARCEL TAX I.D.N PERMIT N <br /> �00.3 w. C�-siNe � I 1�Oq _c�i� <br /> LEGA LOT NO. BLOCK TRACT OR SUBOIVISION N <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PNONE <br /> (3�� � �C� <br /> TENANT NAME CONTACT FOR PERMIT PHONE ZS• <br /> IS��� �� I G . ASTCMY�jO/LS'� E�tnaL <br /> �F��-1►�EN INDV51'21h� <br /> CONTR.LICENSE p <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRtCE OF WORK <br /> ��- Stort-g�E G�2a�°� —Elecfric _Gas_Other 97 �Od0 <br /> WORK DESCRIPTION ������ �r� S��C(, gU f Ll�IN6 <br /> Go�✓s r�-v�7' P <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet WC-air handling units <br /> Balhlub Forced air syslems <br /> Lavatory(wash basin) _ Gas plping <br /> Showor Water heater <br /> Kitchen sink&disposal _ Gas(ireplaca <br /> Dishwasher _ Gasrange <br /> Clothes washer Ctothes dryer <br /> Water hoater Range hood <br /> Sink(service/barlmop/olc.) _ Ezhausl(an <br /> BackOow prevenler __ Heal pump <br /> Udnal Unit hoater <br /> Drinking Founlain _ Bollor <br /> F!oor drain Reingerelion <br /> Groase Irap _ Woodstove <br /> Roof drains O�her_ <br /> O�her , <br /> CITY OF EVERETT LOCAL SALES T/U(CODE IS 9705 <br /> I hernby cerilily that I have read and examined lhis application and know the same lo be lrue and corcecl. All provisions o(laws and <br /> ordinaces governing lhi^�type o'work will 6e complied wilh whether specified herein or nol.The granling of e permlt does nol presume <br /> to qive authority to violale or cancel Ihe provision of any other slate or local law regulating construction or fhe performance ol <br /> conslruction. That I am authorizod by lhe owner ol this property lo perform Ihe work lor which applicalion Is made and I comply wilh the <br /> Sla�e ntractors Law 7B.?,TjRC and 29�. OO WAC. <br /> � ,. 3���09 <br /> Siynaluro of OwnedCo�IractodAu�hurized Agent Date �/ <br /> a <br /> � - --- <br />