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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM '�-�, � � �Z-(j 7� <br /> SITE ADDRESS PARCEL TAX I.D.M P RMIT N ` �� <br /> 1G /�, o , , �/. �'1� "� � �:OOO . 3313 {'� � � � o't <br /> I.EGA LOT NO. BLOCK 7RACT OR SUBC'VISION• <br /> DESC. <br /> OWNER ADDRESS CI7Y/ZIP PHONE <br /> C�i a �<< ��� e?�i-a /� L%�:✓�n��l ��i:�7T� 9.r�S� �-�.3✓�3S''7�G <br /> TENANT NAME CONTACT FOR PERMIT PHONE y„r f �I y��-y, <br /> I !�C/G ��/1/I<�C/7 EdNAIL <br /> �ir„�,r;< r;�:�f, �� a��« �`��N��. ",�� M�;..,ri�i�,�,.,�� <br /> .,�<�-��y�.�y� <br /> CON7R.LICENSE R <br /> ' /s%4 9s<-7'.�' <br /> USE OF BUILDING � I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> l��'f'r��'o�r%� �/3�7Y; v�> <br /> Eleclric �Gas_Other <br /> WORK DESCRIPTIOk <br /> PLUMBING ;dECHA�VICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. T.'PE OF FIXNRE OR ITEM <br /> Toilel _ FUC—airhandlingunits <br /> Balhtub _ Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Water heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clothes washer _ Clothes dryer <br /> Water heater _ Range hood <br /> Sink(service/barlmop/etc.) _ Exhaust fan <br /> BackBow prevenler _ tleat pump <br /> Unnal _ Unit heater <br /> _ Drinking Fountain _ Boiier <br /> Floordrain _ Refrigeratlon <br /> Grease[rap Wocdstove <br /> Roofdrains � Other (-�•.Fun�rt�-.�' <br /> Other — <br /> GTY OF EVERE�fT LOCAL SALES 7A7(CODE IS 7105 <br /> I hereby certiry that I have read snd examined this application and know the same to be We and correct. All provisions of laws and <br /> ordinances goveming this type ot work will be complied with whether specified hereir,�r not.The granting of.�pertnit does no�presume <br /> to give authonty to violate or cancel the provision of any other state or local law regalatlng construcUon or the performance of I �th the <br /> construction. Thal I am authorized by the owner of this property to perfortn the work br which applicaGon is made and I comp y <br /> State Conlradors Law 18.27 RCW and 296.200 WAC. <br /> .�. ,.%� ��'1"/���� �v7 /9 �// <br /> Sgnature of OwnedCont—raCtorrAulhonzed Agent ' Date <br />