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� _ --- <br /> PERMIT APPLICA'TION <br /> CITY OF EVERETT PFRMIT 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 C �a-g—�� <br /> SITE ADDRESS PARCEL TAX I.D.# PEI�RMIT# t� <br /> ���/�� 4l !'r}'. Cl��jlii`"�;��i.::l�ir'�r. �lo�� �V� � <br /> LEGAL LOT NO. ( � BLOCK TRACT OR SUBDIVISION N <br /> DESG ['�� i-Yt'I/ u/�f`/-:� <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> � ' ='F �!`.-; �Fyi'-�`..lc;�,' i-�/,%;�` �la,'..-�jj� �3:r, <br /> y;i ;k,�i�J.ES �/�Y� /�'t:- ,� , , - <br /> TENAffr NAME � CONTACT FOR PERMIT PH�NE !yC �"�fj ;� 7 <br /> f � � I L-ylLi,- /I�!'��GG����- ��k�'�!/r�TlN/f/�� � <br /> ����1rS�= /`�7,�/{-�, e-Ma� <br /> , �TTP�Z o <br /> !� f r 6��� �e`>d�� ��,/��k' �(��C/ I�FyT/�f-�t-f l i;'.f �1�h7G�� <br /> CONTR.LICENSE# <br /> /{,`<ra'��(l ;'r'7iJ`�1 <br /> USE OF BUIIDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> �� �:�`Y j�-�:1.�ll.r�j _Electric _Gas_Other �/�--����D <br /> WORK DESCRIPTION � <br /> i'��"�;%�Z� ��j i� / ;:�il�;f;y/ ��.�..�:�r.. -jY i�'��'�..�,'' / r��7/�7 <br /> PLUMBING MECHANICAL <br /> IVU. � ITYCV�1'IAIUIICVHIICM IYV. I ITYCV��IAIUHCVt111CM I <br /> Toilel _ A/G-air handling uni�s <br /> Balhtub __ Forced air systems <br /> _ Lavalory(wash basin) _ Gas piping <br /> Showor _ Water healer <br /> Kitchon sink 8 disposal _ Gas fireplace <br /> Dishwashar _ Gas rango <br /> Clotlies washer Clolhes dryar <br /> Waler heater � Ran�o hood <br /> Sink(servicelbar/mop/etc.) � Exhausl lan <br /> Backflow prevenler _ H�at pump , <br /> Urinal _ Unil healor <br /> _ Drinking Foun�ain Boilei <br /> Floor drain Refrigeration <br /> Greaso Irap Woodstove !, <br /> Roof drains � Othor /liAF�r-�/��f1i1�>],� <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3f 05 <br /> I hereby ceritily Ihat I have read ar�d examined this application and know ihe same lo be irue and correct. All provisions of laws and <br /> ordinaces governing this typa of work will be complied wilh whe�her specified herein or not.Tha granting of a pormi�doos no�presume <br /> to give authoriry lo violate or cancel lho provision of any o�her slale or local law regulating cons�ruclion or Ihe performance of <br /> conslruction.Thal I am aulhorized by ihe owner ef this property to perform Ihe work for which application is made and I comply wilh Iho <br /> State Conlractars Law 18.27 RCW and 29G.200 WAC. <br /> ] /L.-�-. ,yf i„; <br /> � �.�� ///i . �-j %-//%� 7 � <br /> Signature otC?wneY/ConlraclodAut iorized Agent Date � <br />