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� � <br /> _ � -- , --------- - <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> i <br /> ��, APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM C( �-a.s-Q � I <br /> '�� SITE ADDRESS 7 SO/ CYC/�✓6��� PARCEL TAX I.D.# PERMIT# � <br /> �� F��.��; �,.� 9�o z3 . ��;y,�-��� �o����,� 3osoN- �_3�__ �I <br /> ' LEGAL lOT NO. BLOCK TRAC7 OR SUBDIVISION# I <br /> DEtiC <br /> I OWNER ADDRESS CITYIZIP PHONE I <br /> � �i <br /> ! �E l �-1 C� <br /> ��I 7ENAN7 NAME CONTAC7 FOR PERMIT PFIONE 2pL . 4y 1 � I y.1(� ' <br /> �, 3i/� �� S G-� L I S A �b LST�-`Z E-MAIL �-. �l..}TgRCd M W�M <br /> Z/ <br /> ' NTRA R / A RE f / IP PH � �t���,i�-.I � <br /> � ��/u��'� �/�2 7�l ` � �'t.o-� �/�on�vi( ('.o�" <br /> � ' "� � <br /> i GONTR.LICENSE K -/-bg, :A�.. ��/.�`n � ° � � f � '71.F'Ld� L' � �- . , <br /> dc-'b �-f� �,� �' �� .. % :�. <br /> ' USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ', _Electric Gas . Other � 8 � O�� , <br /> I' WORK DESCRIPTION . <br /> �. INST�4U�kTLO� Q�' ✓�"IoD�IL.R�� O�'�� G� IJI �,l17�, i <br /> ', PLUMBING MECHANICAL <br /> I NO. 7YPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM '�, <br /> � Toilet ._ A/C-air handling units � <br /> BatMub __ Forced air sysizms �, <br /> II, Lavatory(wash basinl _ Gas p�ping ��� <br /> Shower _ W�terheater I <br /> Kilchen sink 3 disposal _ Gas tireplace I <br /> Dishwasher _ Gas range <br /> � Clothes washer ___. Clothes dryer I <br /> I Water heater Range huod <br /> � Sink(service/bar'mop/etc.) _ Exhaust tan � <br /> � Backtlow preventer _ Heat pump <br /> Urinal Unit heater <br /> �; Drinking Founnin _ Boiler <br /> I Floor drain ,_ Refrigeration <br /> � � Greasetrap ._ Woodstove <br /> � Roof drains _ O�her___ _ <br /> Other -- — -�—"— <br /> — -- <br /> �' — ___-_— _' — -- —___.__--_ I <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 � <br /> ��,, I Fsreby ceritify that I have read and examined this application and know the same to be true and correct AII provisions of laws and <br /> I ordinaces governing this type of work will be complied wi�h whether specified herein or not. The granting ot a permit does not presume II <br /> �! to give authority to violate or cancel the provision of any other state o�local law regufating construction or the pertormance of <br /> . '� construction.That I am authorized by Ihe owner o(this properly to pertorm ihe work tor which app!ication is made and I comply with the <br /> �� State Contr rs La�N RCW and 296200 WAC. <br /> /�. � <br /> ���. Sign ure of wnedConlr2ctodAuthodzed Agent Date <br /> ' �Z J <br />