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h �(���� �4 ���^ � S P RMIT APPLICATIO�V <br /> . � P . f. <br /> : � �� -'� Yv��'•, CIT`.' OF EVERETT PERMIT SERVICES <br /> � 3200 �.EDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810– FAX 425-257-8857–www.everettwa.org <br /> APRLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS /' PARCEL TAX I.D.# PER�MI,T,J#� <br /> 4j� .�"� � ` �irt( 'r+Pl'����`% �'U� � 7y���(�J.Z30Z ��(�' �J�y <br /> LEGAL LOT N0. BLOCK TRACT OR SU'^BDIVISIO/N p <br /> DESC. � �Op — OZ S P �I(/ �( <br /> �O NER ADDRESS CITYIZIP PHONE y LS'� <br /> � �0/1 �E� /lGr �iA/ � 5�.� 3 ��tGllithP r�'tll'Z. �VN1�t�'�//r5.203 3s0"6QS2/ <br /> TENANT NAME CONTACT FOR PERMIT PHO E �{LS"-3$"f3 —D�'j S <br /> I�E�^ �`t�I E�MAIL <br /> L TR T � �� ��--pROR� <br /> �G h'0 I`{d/� C' S ��13 (yur��neor �UE�. L"Ve4efY� %fl.J.G�3 YLS- 3sa •o �S'y <br /> CONTR.LICENSE M <br /> E u!�v y/f -#c 9 7zN:J' <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � Il tiv <br /> '' Electric ✓Gas Olher � O <br /> 5��+ �I� r �ti/tir'�i, �e5�tf�,cc <2 — — — �OV <br /> WORK DESCRIP/TION ,f I , ' � t <br /> � � h(.ti �GC/ fE' ll � A ih9 q(n„G� /VGtd'f� J ��9� J � /l�V6(OFt�' (�f jfh(} �} 1 <br /> J I J <br /> � �i�'r �ls �v F/�� <br /> � PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toi�cl A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas pipinc� <br /> Shower Water hoater <br /> Kitchen sink&disposal Gas fireplaco <br /> Dishwasher Gas range <br /> Clothes washer Clolhes dryer <br /> Waler healer Range hood <br /> Sink(service/barlmop/e�c.) _ Exhaust(an <br /> Back(low prevenler Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeralion <br /> Grease lrap Woodstove <br /> Roo(drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerili(y Ihat I have read and examined ihis applicalion and know lhe samo to be lrue and correcl. All provisions ot laws and <br /> ordinaces goveming lhis type of work will be complied wilh whelher specified herein or not.The granling of a permil does not presume <br /> lo give authority lo violate or cancel the provision o(any other slate or local law regulaling conslruclion or the peAormance of <br /> construclion. That I am authorized by the owner of lhis property lo perform Ihe work for which application is made and I compiy wilh the <br /> Slate Conlractors Law 8.2 �nd� /�.2�00 WAC. <br /> ,'� ((�f,.-�/',� � '�, ��F�u' � ' -5 ' Og <br /> SignaWre of OwnedContraclodAulhorized Agenl Date f/ <br /> � � <br /> I <br />