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F :RMIT APPLICATI�. �V <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STktt i, tvtkE 1 I, 1N,4 y8201 <br /> 425-257-8810— FAX 425-257-8857—www.everethNa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM J �3�l0 <br /> SITE ADDRESS PARCEL TAX I.D.� P RMIT# <br /> !U.30J FU��2G��'�u l,c�h- � /�'�3 - Q�� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBUIVISION# <br /> DESC. <br /> OWNER �Q.('I , ADDRE55 CITYIZIP PHONE y2q �-EZcr� <br /> �x,T�-� i�,N�E P�t�•r- L L L <br /> �./� /�,4c� F�c �ss�i r!"�fl�v,so�z� 600 �ofs'"AvF NC Su�l� 5"3� (�!«uv� � 95j�`t <br /> TENA�ME CONTACTFORPERMIT � PHONE <br /> ,� '�7 (µ2s) 53i-aFs'�Y <br /> 1- �-/Ui E�c I L (�90CL F L E-MAIL £P+L�CcXYKQF2C,e��, Ccu/ <br /> CONTRACTOR ADDRESS CITYIZ P PHONE <br /> Cva-rcet��z P�t �srA•rE ssv"u'�es, ,�c <br /> CONTR.LICENSE# �ZLy3� pU�T(� /�� � /SSAQ�'i �✓h �{Z7 Z> 5-�63� 9 <br /> USE OF BUILDING HEAT SOURCE Cf�NTRACT PRICE OF WORK <br /> A�S���7�v% _Electric �Gas_Other �•� y 3 3. �G <br /> � <br /> WORK DESCRIPTION ��I�I�C�r-/r�.N '� CJ r �O � Q� �Y �l?tolZ �C�j,¢f L Th��i'T <br /> ���1--_. �hr-,�-a�c,� �y v�,-�,�e� „tiP�% <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet AIC—air handling units <br /> Bathtub Forced air syslems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower � _ Waler heater <br /> _ Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> _ Clolhes viasher ;� _ Clothes dryer <br /> Wa�er heater % _ Range hoo�l� <br /> _ Sink(service/b"arlmop/etc.) _ Exhaust f�n <br /> Backflow�reventer _ Heal purrfp <br /> _ Urinal _ Unit heater <br /> _ Drinking�=ountain _ Boilef <br /> _ Floo�drain = Re iigeration <br /> _ G�ase trap odstove <br /> _ f}oof drains _ iher <br /> ;Other <br /> — — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby certify tliat I have read and examined this applicalion and know ihe same to be true and correct. All provisions of lavas and <br /> ordinances governing lhis lype of work will be complied wilh whether specified herein or not.The granting of a permit does not presume <br /> to give au�horily to violate or cancel Ihe provision of any other slate or loral law regulating conslruction or the performance of <br /> conslruction.That I am authorized by lhe owne lhis progerty-to-perfo�r n lhe work for which application is made and I comply with�he <br /> Stale Conlractor Law 18.27 RCW and 296.2�0-W . i <br /> .--^ - <br /> �:-- - _ - --3 2� z�ro <br /> Signature of OwnedCo�rad dAulhorized Agent �ate <br /> / <br /> t� � <br />