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' �,J��/�' �r'/r't'c�vc�l <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR Sl'REET, EVEREI7, VJA 98201 <br /> 425-257-8810 - FAX 425-257-8857-www.everettwa.org <br /> APPLICATIf)NS ARE ACCEPTED FROM B AM TO 4 PM - DEBIT&CREUIT CARDS ARE NOT ACCEPTED <br /> SITE AUDRESS �-" �� .� � PARCEL TAX I.D.p pERMIT q <br /> :�7c 7 Ct.����/ �1vt�: (�`t��. rx,� ���i4�ascz�/co ,/-;� Z J - <br /> LEGAL LOTNO. OLOCK TRACT <br /> DESC. v�s <br /> OWNER ADORESS SurjL / � y`rp CITYlZIP PHONE <br /> (y�s��s2 - <br /> i7=�JK�ie�i�L a7o7 c��f�Ac1G, ���'��r�, �ua- �jB.�o/ s��'z, <br /> TENANT NAME CONTACT(�OR PE4MIT L � �f���� P O <br /> / 1� n/.i- ,�-,�_�/Ti:'!TJ <br /> G ��i�: � � c , <br /> K y �QiLL P�73.,C i T�r .,75.� -.f3.'- 5/.?'c.�n <br /> CONTRACTOR ADDRESS CITY2IP PNONE <br /> �Z� ��� i��?l',Ei�1ii.lCi� <br /> CONTR.L�CENSE tl <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ��7L,�� Electnc _Gns_Otber ���� — �/a oc <br /> WORK DESCRIPTION <br /> ��7✓� c�ivi{�: �vrst� ;�i irinc/ rX/STin/G K�irl• �D i1�'TtIJjMGJrS �` C iG�rl TieJG <br /> ,fl�iC�NCutL' GVL h,�c,-l.MJicf[. r2�¢z.���.j. I'1CM�vG ,S/`f�.JiiJb v�tc. .�T � <br /> /=lvM ,�r�TiG��'L , <br /> PLUMBING MECHANICAI <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet AIC-air handling units <br /> Bathtun Forced air systems <br /> Lavatnry(wash basin) Gas piping <br /> Shower Water healer <br /> Kitchen sink 8 disposal Gas fireplace <br /> Oishwasher Gas range _,//��. <br /> _ Clothes washer �/� C�othes dryer !ti` <br /> Laundry tray Rango hood <br /> Sink (service/badmop/elcJ Ezhaust fan <br /> BackOow preventer Heal pump <br /> Unnal Unit haater <br /> Drinking Fountain Beiler <br /> Flour drain Refngoralion <br /> Grease trap Woodstova <br /> Roof drains Other <br /> other — <br /> CITY OF EVERETT LOCAL SALES TA7C CODE IS 5105 <br /> I hereby ceritify that 1 have read and examined Ihis appiication and know the same to be tnie and cortect. All provisions of laws and <br /> ardinaces governing this type of work will be complied wifh whether specified herein or not.The granting ol a pemiit does nol presume <br /> lo give authority to violate o�canc I�he provision of any other slate or local law regulaling consWction or�he pedortnance of <br /> consUuction.That I am iioriz . y the owner of this property to pertorm Ihe work for which applicalion is made and I comply with Ihe <br /> Stale ContracW �aw .27 and 296.200 WAC. <br /> ��� `S t� L .J,? D <br /> Sign ure of OwnerlContractodAujhOrtzed Agent � ale �� <br /> L � <br />