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PcRMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERE"i T, WA 98201 <br /> 425-257-8d10- FAX 425-257-8857 - www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �., -� (�-O� <br /> SITE ADDRESS <br /> - ��-> PARCEL TAX I.D.# PERMIT A � <br /> ` On� V,� , C /� �i.✓����� 1� �-C�g <br /> LEGAL LOT N0. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> ��q �� IrJ <, <br /> TF.NANT NAME COTNTACT FOR PERMIT Pr10N ( �/' c.,� <br /> �J(1(.�i f �/ � {1-�� I L� M I' n I'-j r_� � E-MAIL � ' � l �� <br /> 9' <br /> _L`afJT�FICI. _ <br /> j/%r y /✓; C/t-1��,^,U Gi,Nc� <br /> CONTR. L�CENSE M <br /> USE OF BUILOING HEAT SOURCE CONTRACT PRICE OF WORK <br /> '��>�1L � � i��/t G� �_Elodric _Gas_Olher �S ��� �On <br />' WORK DESCRIPTION <br /> .� '� <br /> G�,��; ��,����,T 7���;� S�i �� '(s'3 �- <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilal A/C–air handll�g unils <br /> Bathlub _ forced air systoms <br /> Lavalory (wash basin) __ Gas plping <br /> Shower W ater healer <br /> Kilchon sink 8 dis{wsal _ Gas tlreplar,e <br /> Dishwasher Gasrange <br /> Clolhes washer Clolhas dryer <br /> VUator hoatnr Ranga hood <br /> Sink(servico/hadmoplalc,) _ Exhaust fan <br /> Backllow praventor ___ Heal pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Relrigeralion <br /> Grcaso trap _ Woodstove <br /> Ro�f drains Olher _ <br /> Other <br /> CITV OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I horeby ceritify that I have read and ezamined this applicalion and know the same lo be true and corred. All provisions ol laws end <br /> ordinaces governinp this type of work will bo complied wilh wh,ethr,r spocified herein or noL Tho granting of a permit does nol prasume <br /> lo givo aulhoiiry lo violato or cancol tho provision of any other slaln or local law regulating construclion or the perlormance of <br /> conslructioa That I am authorizeA by lhe�owner ol Ihis property to podorm th�or which appticalion is made and I compiy wilh lho � <br /> Stato onlractors La�j' 1 7 RCW a 296.200 W�C. 1y� <br /> �rl-�...w.��%i a,���.��1 S !,`7 �/ <br /> Signatur�ol OwnedConlraclorlAulhonz�d Agm�t Dale <br /> i. . _ . ._ .. - ---------- ---------- — <br />