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PERMIT APPLICATION <br /> CITY OF EVERET7 PERMIT SERVICES ; ;�`�� <br /> 3200 CEDAR STREET, EVC.RETT,WA 98201 �� � ' <br /> � �, <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.# PER x <br /> 11 /D� ��,�� r����, (,<lu �`E 00`1y�9oU3Cb7�0 j c1 -oo� <br /> LEGA LOT NO. BLOCI TRACT OR SUBDIVISION if <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> �i.�ro,ray �n�x�r �res LtG �9i29 QucJ:e� �G ��oo ���fl: i.J� ��s,�o ► <br /> TENAN AM I CONTACT FOR PERMIT PHONE �H1eS 7 76-ttFs,iS <br /> L i�N Fx � � G ri �a ! E d ` f e-Ma .w�3 v� r.ir r�t <br /> �rry /�r�+_� 5 ;�_� ay5fGW5 7y00 I-�ardtse-t �o� �ltJc'� l.�i� �7$7lJ.j <br /> CONTR.LICENSE N /� <br /> f3El1RYNC m 7 7G.�/I L`1J3'.�?76��� <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��µe 4���I _Electric _Gas_Other �$ C(�g.� <br /> WORKDESCRIPTION��i 1� ' . � II L�� mo� ulti�I St��1 �'t4'�✓.•�.5 i�-2'•rnc.Ily ���IrJw,'.��s) <br /> CCL .F ��l� <br /> o�e�n e l�a.��E� lef�l ars w� �rms.l -.^�r,�c �o�.�-�r�,� � ex�enw 1 „�t:�'..� ra�ew�,i <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI7(TURE OR ITEM <br /> Toilet A/C-air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/barhnop/e�c.) Exhaust fan <br /> Backflow preven�er Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains O�her <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritily that I have read and er.amined this application and know the same to be true and correct. /�ll provisions of laws and <br /> ordinaces governing this lype of work will be complied with whether specified herein or not.The granting ot a permit does not presume <br /> to give authorily to violate or cancel the provision of any other state or locai law reguiating consiruction or the performance of <br /> construction. That I am aiithorized by the owner of this property to perform the work for which appiication is made and I comply with the <br /> State Co racto s Law 18.�RCWpnd 296.200 WAC. <br /> �G , ` Fe 6f r ,�� <br /> S n ure o( ner ontracror/Authorized Agent Date <br /> ��Z <br />