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PERMiT ,APP�LICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-887 0-FAX 425-257-8857-wvuw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � ���J S � O�� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMiT ri <br /> ��u Cz�s �:923 -�-�o's -o� �ly?7 <br /> LEGAL LOTNO. BLOCK TRACTORSUBDIVISIONS <br /> DESC. � �� -0 � � <br /> OWNER ADDRESS CITY2IP PHONE <br /> '7ft� �9Zu�'�r10ic J�+�v ��� ia� �/��vtc� s ��inrs,u�. 20�-sa'� - os�� <br /> TENANTNAME I CONTACTPORPEFiMR PHONE �OG" (c8Z" �B��J <br /> 4//Nirt/ /I/�'r / G�/�I1�GL� E•MAIL/vr.�'�..-'j�y�J 1/N � u:N <br /> Z'L?LG'EMrtNd2 ��' 3G'�/ �'r' I�o. S. �/tLl3�c�;'1. c�iG�Gd2� ?.�53 <br /> CONTW.LICENSE p <br /> /�G�PG�96�'/ - <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ����.r _Eleciric _Gas_Other �/(�."L%•DU <br /> WORK DESCRIPTION �O(7l�/✓ DdC ��� S�A-`�� �C%1'��/'� ���T��' <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITHM NO. 7YPE OF flKNRE OR REM <br /> Toilet _ A/C-airhandlinguniLs <br /> Bathtub __ Forced air systems <br /> _ Lavatory(wash basin) _ Gas piping <br /> Shower _ Waterheater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> C ihes washer _ Clothes dryer <br /> — Ran e hood <br /> S nk(serviceelbar/mop/etc.) _ Exhausl fan <br /> Backllow preventer _ Heat pump <br /> Urinal _ Unit heater <br /> _ Drinking Founlain _ Boiler <br /> Fiocrdrain _ Relrigeration <br /> _ Grease trap _ Woodslove <br /> _ Roof drains _ Other N�� <br /> Other_�(�i 4 — <br /> — i <br /> � <br /> CRY OF EVERETT LOCAL SALES TN(CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same to be true and co.racL All provisions of laws and <br /> ardinaces goveming this type ol work will be complied with whether specified herein or not.The granting ot a permit does not presume <br /> to give authority to violate or.:ancel the provision o(any other state or local law regulating construcGon or the performance ol <br /> construction. at I am auth rized by the owner of lhis proporty to perform the vrork for w+�ich application is made and I compiy with the <br /> State Con s Law 78. I W and 296200 WAC. <br /> 7l� • S � .4� <br /> Signa re of Cwner/Con todAuthorized Agent Dat <br />