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PEr2MIT APPLICATIOrI <br /> CITY OF EVERETT PERMIT SERVICES �� �v5 —a � <br /> i 3200 CEDAR 5TREET, EVERETf, WA 98201 C07b6-� <br /> 425-257-8810- FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# ERMIT ft <br /> �:�i�� ���,�� /ar�• ctitlzeT l�. �, � 7�[� -�� <br /> LEGA LOT N0. BLOCK TRACT OR SUBDIVISION# <br /> DESC. � ' � �[;� r. � <br /> OWNER ADDRESS CI 21P PNONE . , . <br /> �iC � GdSP� /�'IiSs/ �o�/ aal�/ �o�a�a L��tir ��TT, l�R. ��'Zvi 4.�53�;-s� y.. <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> E-MAIL <br /> ONTRAC R �q�,r'�c ���s�ll D SS � I <br /> � � ��,r��.�as�� r—c�r�n� w�aa . ���. 980�� as3 a�-�Y�o � <br /> CONTR.LICENSE# � <br /> I�/,�=i/-'?T 9 5 � — <br /> USE OF BUILDING I HEAT SO,URCE � ONTt3ACT PRICE OF WORK <br /> / 7 1 <br /> I _Eleciric �Gas _Ulher � p �f�c� ' <br /> WORK DESCRIPTION <br /> � <br /> �v��.r� ���7�' .�Pra <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilel ' , � A/C–air handling unils <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping '��( <br /> Shower Water healer i(` <br /> _ Kilchen sink& disposal _ Gas fireplace (1��� <br /> Dishwasher Gasrange �,,p � � <br /> Clofhes washer Clothes dryer \ � <br /> _ \Nater healer Range hood � p i� <br /> _ Sink(service/badmop/etc.) _ Eahaust 1an �u �\ <br /> _ Backflow prevenler _ Heal pump �Q <br /> Urinal Unit healer i <br /> Drinking Fountain Doiler <br /> Floordrain Refri er 'on <br /> Grease trap Woodstove <br /> Roo(drains r t-�'tvYV <br /> �IOlher SP�' .Ti�1�Accl97�u�N � — <br /> CITY OF EVERETT LOCAI SAIES TAX CODE IS 3705 <br /> I hereby ceritify that I have read and oxamined this applicalion and know the same to be true and correcl All provisions of laws and <br /> ordinaces goveming this type o(work will be complied a�ith whether spec�(ied herein or noL The yranting of a permil does nol presume <br /> to give aulhority lo violale or cancel the provision of any olher state or Iocai law regulating consWcliun or the periormance of <br /> construction.Thal I am authorized by lhe o�vner of lhis property to periorm�he work for which application is made and I comply with the <br /> Slate Contractors L 27 ClN and 296. 0 WAC. <br /> � � / <br /> `/ . Cc G���� <br /> Signalure o(OwnedConlraclor/Aulhorized Age Date <br /> 1� <br /> L! -- <br />