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PERMIT APPLICATIC�N <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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> �-iP 0 l' �Yz t�l. 4#7 iM f D I� -D 3 � <br /> LEGAL LOT NO. BLOCK TRACT OR SUBOIVISION# <br /> DESC. � <br /> OWNER ADDR[SS CITY2IP PHONE <br /> TENANT NAME CONTACT FOR PERMIT PHONE (�ZS-ZC��-�BO� <br /> �U.'r�C� D�1 I I�v1��� / I , C�Z-Z OI� C� E-MAIL Q.✓�C�OVJI�Al1V�C <br /> C TRAC R ADDRESS CITYIZIP PHON �ILIVj .0 �`(� <br /> cexc����-v, �rA=bhc� �j(nfn �U�v�� �,c.ny �uc,t�r <br /> CONTR.LICENSE# � ��-�g'�� L��`�1��� <br /> USE OF oUILDING I — HEAT SOURCE I CONTkACT PRICE OF WORK <br /> Electric XGas_Other <br /> WORK DESCRIPTION <br /> I�ly-�u II {�-� ��� �vn�ic�. •(- �� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM � NO. TYPE OF FIXT�RE OR ITEM <br /> Toilet f AIC—airhandlingunits <br /> �athlub � Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Showar _ Water healer <br /> Kilchen sink&disposal _ Gas fireplace <br /> Dishwasher __ Gas range <br /> G�t�es wdsher _ Clothes dryer <br /> V��ater:iealer _ Rangehood <br /> Sink(servicelbar/mop/elc.) _ Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal _ Unil healer <br /> Drinking Fountain _ Boiler <br /> Floordrein _ Refrigeration <br /> Grease trap _ �Voodstove <br /> Roof drains _ Olher <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y lhat I ¢ave rea and examined this ap licaliom�nd know the same to be We and correcl. All provisions of laws and <br /> ordinaces governing �f�is type o work will be complie v:ith whet er specified herein or not The granling ot a permil does nol presume <br /> to give aulhority lo viotate or c cel lhe provision of . y other st te or local law rec�ulating constr�ction or tha performznce of <br /> construcliq .Thal I am a�thn by the ner of lhi roperty o perform the work for which application is made and I comply with the <br /> State Co�lra tors La�v 18.27�C d 6. 00 C. <br /> ; �2 �l � <br /> .Signatu e o 0 ontractodAutho zed Agent � ate <br /> I <br />