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L—� ,2c�+s tv� <br /> � <br /> PERMIT PLICATION <br /> CIN O� RETT PERMIT SERVICES <br /> 3200 DAR STREET, EVc'RETT, WA 98201 <br /> 425-257 10- FAX 425-257-8857 -www.everettwa.or9 O <br /> � �'-� S 2� <br /> APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PN ,\ / _ <br /> SITE ADDRESS '�j��' � ' 1"��G 1� +r� ��'�' v� —O� v <br /> PARCEL TAX I.D.• ' ERMIT N <br /> LEGA LOiNO. i �� � v��. 1��I��'• _- -� . <br /> I BLOCK TRACT <br /> DESC. " �`'� � <br /> OWNER � <br /> ADDRESS CITV2IP PHONE <br /> ���� �� H��-,,d,� z��� e,��p,Y �J�. alq�rr ��-zr�2-2e�� <br /> TENANI'NAM�E/ COHTACT FOR PERMR <br /> V�CUG � IA`/,' I �J1 �� PMOHE <br /> Iti 1 � '�ht�1 � q�j-�jl`�- �'�'4- <br /> CONiRA fOR ADORESS <br /> Cm21P PHONE <br /> CON .LICEHSEI ��J IP�1Ll✓1� vl��``,...�V � L� 34"�� C � Z7 <br /> US OF BUILDING HEAT SOURCE <br /> �� � ( r-7 f`�� Eledric CONTRACT PRICE OF WORK <br /> �, � �Gas_Other �1 <br /> W K DESCRIPTION <br /> " . �c <br /> I�c-�r� � ���c�� 7o��er 20�.� ,�n tuN� to �11� �.,�'�mr- r <br /> � • ���L < l�'r E Ji f-NO �%1� OIYt V�(M� <br /> PLUMBING � ' <br /> MECHANICAL <br /> TYPE OF FUCTURE OR ITEM NO. TYpE OF FIXTURE OR ITEM <br /> �_ Toilet <br /> _� Bathtub A/C-eir handling units <br /> Lavatory(wash basin) � Forced air systems,�-CFir y,�/v(y <br /> ! Shower _ Gas piping '�r <br /> _ Kltchen sink 8 disposal ._ Water healer <br /> Dishwasher _ Gas fireplace �W <br /> Clothes washer _ Gasrange <br /> Laundry tray � Clothes dryer <br /> � Sink(service/badmop/e1cJ fC i�cp,� Ranye hood � V� <br /> BackOow prevenler � �hausl fan �i�'C F�rv� <br /> - — Urinal _ Heat pump <br /> � Drinking Fournain _ UnN heater <br /> Floordrain _ Boiler <br /> _ Grease trap _ Refigeration <br /> Roof drains � Woodstove <br /> _ Other _ Other <br /> �_ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7705 <br /> I hereby ceritify lhat I have read and ezamined this application and know the same to be Irue and corred. All provisions of lawe and <br /> o�dinaces governing this fype of work will be complied wilh whether specified herein or not.The granting of a pertnil dces not presume <br /> to give authorily fo violate or cancel Ihe provisi�n of any other state or local law regulating construclion or Ihe peAormance of <br /> conatruqion. That I am authorized by ihe owner of this property to pertorm ihe work for which appiicalion is made and I comply with lhe <br /> State ConlraFfws Law 18.27 RCW and 296.200 WAC. <br /> Signature of Owner/Contrador/Authonzed Agent ��'�—"-� � <br /> ate /) <br />