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NERMIT APPLICATIt�N <br /> CISY 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 � —a�$ --O� <br /> SITE ADDRESS PARCEL TAX I.D.0 PERMIT N <br /> L � Gv� ff� �'lugC) �S-v3�S _ <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION k <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHON ��` ���� , <br /> ����-�� I �u�� �� {� Z7v7 Gol�vA�, �"�rc.�u2G� ' <br /> T,YE7NANT NAME CONTACT F R PERMIT PHONE <br /> 1 \UI�r�S E-MAIL <br /> CONTR 0 AD i CITYI IP <br /> � I� J�� I�V�G �>�ZH l��" �� /J� E,;cr�� �f 25).SoP'�iY�y <br /> ONTR.LICENSEiI��� ^���C� � ^ C��Z(� <br /> �� 7 f� <br /> USE OF BUILDING HEAT 50 RCE CONTRACT PRICE OF WORK <br /> �< ,I O fN N� � I _[lectric Gas_Other � �� U�/� <br /> / T"�- <br /> W���F'��y�s �����,�� ti��, � � r�,��, nu� t�J,�,��,5�,;���� <br /> � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilel �, A1C-air handlinc�unils . � <br /> Balhtub . � , Forcod air syslems <br /> Lavalury(wash basin) � 'Gas piping <br /> Shower Waler healer <br /> Kilchen sink&disposal _ Gas(ireplace <br /> Disliwasher Gas range <br /> Clolhes washer _ Clothes dryer <br /> Water healer Range hood j <br /> Sink(servicelbar/mop/etc.) � Exhausl fan <br /> _ Back(low provenler _ Heat pump � �� <br /> Urinal Unil heater \ j�� <br /> Drinking Fountain _ Boiler ��" <br /> Floor drain Refriger2tion <br /> Grease trap _ Woodslove <br /> Roof drains O her � <br /> _ Ofher �— � ��1�� r� <br /> V <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> I hereby ceritify lhal I have read and ezamined lhis application and know the same lo be true and cortecL All provisions of laws and <br /> ordinaces governing ihis typa of worrt will be complieJ wilh�vhether specified herein or nol The granting o(a permit dues not presume <br /> to 9ive authonty o violate or cancel the provision of any other state or local law regulaling consWction or Ihe performance of <br /> conslruc'un. T �l I a autho f{ed by Ipe owner of lhis property lo periorm Ihe work tor which applicalion is made and I comply wilh tlie <br /> Slate ntr rs w 18.7 kCW�r(d 296.200 WAC. <br /> �., ���,' �,� ZS <br /> Si aWre of OwnedContractor/Aulhonzed Agenl Date T/ <br /> L <br />