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P�MIT APPLICATIO� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 q ,.�.�I�D� <br /> 425-257-8810- FAX 425-257-8857 -www.everettwa.org ��' ��� y I <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS AR NOT ACCEPTED � <br /> I <br /> SITE ADDRESS PARCEL TAX I.D.ti PERMIT p, <br /> 3�2U = Zb��' PcVE � �U� �o�.0\2O0 �-cyos -oz5 _ � <br /> LEGAL LOT NO. BLOCK TRACT <br /> �esc. �Z � 13 (7Gc�. \-�Eu�Z�`t" Nc'S(�HT /'�n0 TQ E�.G��"� j <br /> OWNER ADDRESS CITY2IP PMONNZ�_3q.�_.�3c-o i <br /> 1�A�c� �3�'�13 �-�5 3��aa ��A�c J�E ��Ee�� Q`c2cS <br /> TENANT NAME CONTACT FOR PERMIT PHONE '� <br /> � ��,�c. !-��a�l� �z.s a��c �,�a4 - <br /> CONTRACTOR ADDRESS - � ' �-� CITY2IP PHONE , <br /> N�lack gt'�c>rN���s 3y�a o, ,i� AvE.N� E�cR�zz S�Z��s i <br /> CONTR.UCENSEq 1i���`� �,=� ,,Z� Z � L.{Z,S� 3G1'� �C�G <br /> USE OF BUILDIIJG HEAT S�'JRCE CONTRACT PRICE OF WORK I <br /> S.� � I _ � _ ZGc� �c;c� <br /> Electric Gas Other i <br /> WORK DESCRIPTION /, � <br /> N Ew S �_ � �S/G � ! <br /> // 7 � <br /> PLUMRING MECHANICAL � <br /> NO. TYPE OF FIXTURE OR ITF.M NO. TYPE UF FI%NRE OR ITEM � <br /> �_ Toilet _ AIC–air handling umcs i <br /> � Bathtub ,y Forced air systems <br /> � Lavatory(wash basin) � Gas pip�ng <br /> Shower � Walerheater <br /> �_ Kilr.hen sink 8 disposal 1_ •:+as fireplace <br /> i Dic'�washer � Gas range I <br /> L Clothes washer I Clothes dryer <br /> Laundry lray � Rango hood <br /> Sink(service/badmoplelc.) � E�aust tan i <br /> BackOow preventer — """�1f°N i <br /> Urinal Unit healer <br /> Drinking FounWin _ Boiler <br /> Floor drain _ Retrige2tion <br /> Grease trap Woodstove <br /> i Roof drains + Olher <br /> I _ Olher = <br /> I — i <br /> i <br /> � CITY OF EVERETT LOCAL SALES TAX CODE IS 7705 <br /> I <br /> II <br /> i I hereby cen6fy that I have read and examinod this appiicatlon and know the same to he We and conact All provisions of laws and � <br /> i� ordinaces goveming this type of work will be complied with whether specified heroin or noL The granUng of a permit does not presume �I <br /> to give authority to violate or cancei tho pro��sion af any other state or lowl Iaw repulating conswction or the peAormance uf <br /> ! cons ction.Th I am autho 'zed by the owne of�his GroPertY to pedorm the work for whlch app��caUon is m,+ua and I comply w;th the � <br /> � State to w 18.27 and 296. ��wac. <br /> i i <br /> � � �, a, �D -?s�� <br /> � � <br /> Sign ture ot ner/ ontractor t nzed A — ate - - - — — �Iy� <br /> � <br />