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�ERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERV9CES <br /> 3200 CEDAR STREET, EVERETT,WA 982p1 <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.# PERMIT# <br /> y� l� G�kVC i'!'e t�:G�i, #� M�oo� -a�� <br /> LEGAL LOT N . BLOCK TRACT OR SUBDIVISION# <br /> �ESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> rnO��V�av��� L�c `�u�o -ev����� w��� �-� ���� y2� _ZS� ►� <br /> CONTACT FOR PERMIT PHONE <br /> TEN/A�N�TNAME /� �� ��^�, '�O� <br /> ' / ,L�/�L G��� ���. C.� �Jv�S�I�l/\.Ul�` CIIYIZIP E-MAIL PH G <br /> ONTRACT R \n� '/ � �L ����� <br /> �w14�1'1 ��lt�,lfi� �� � t� l0 �I�,w�� � �2�� � ��7 <br /> C TR. CENSE# n �y <br /> }� -N <br /> USE OF ILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> Ca`nn 4�, n 1 A , _Electric �as_Other I R I� �Q� <br /> � r� w��� <br /> WORK DESCRIPTION <br /> �VIGi��� N� ��I Q�-'� �Ud}1 p �C�C�C�Z U� lT_ ���t'� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM ' NO. TYPE OF FIXTURE OR ITEM <br /> Toilet ,_ A/C-airhandlingunits <br /> Balhtub _ Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Water heater <br /> Kitchen sink&disposal _ Gas tireplace <br /> Dishwasher ,_, Gas range <br /> Clolhes washer _ Clothes dryer <br /> Water heater _ Range hood <br /> Sink(servicelbarlmop/etc.) Exhaust fan T <br /> Backilow prevenler �� Heat pump l �GtC.jCCt`� � l <br /> Urinal � Unit healer () <br /> Drinking Founlain ,_ Boiler <br /> Floor drain _ Refrigeration <br /> Grease trap _ Woodslove <br /> Roof drains _ Olher <br /> Olher — <br /> G TY OF EVERETf LO SALES TAX ODE IS 3105 <br /> I heraby cerilih�lhal I have read d exami d this applicati and know ihe sam lo be irue and correct. All provisions of Iaws and <br /> ordinaces governing this type work will e complied with hether specified here n or not.The granting oi a permit does not presume <br /> to give authorily to violate or ncel lh rovision of any o er slate or local Iaw r ulating construclion or Ihe per(ormance of <br /> construction.That I m authori e owner of lhis pr perly to periorm lhe w rk for which applicalion is made and I comply wilh lhe <br /> Slate Contraclor� w 18.27 RC a� WAC. ,, 10 <br /> Signat of 0� r onU lodAulh 'ze genl Date <br />