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. � <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-881 U—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.N P T 1f <br /> C�,�,3 ,� r � c0�/D �ccC'C �l�vG' � I - <br /> LEGA LOT N0. BLOCK 7AACT OR SUBDIVISION N � <br /> DESC. oO� <br /> OWNER AOORESS CITY2IP PHONE 1-�25 _ <br /> ��i�� �-I��n h1 , ����;Sn IJ �'�oa3 � Ip�� �r, lti�. EvP��P+� R�023 5c�i- 355`� <br /> TENA ITNMIE CONTACTFORPEHMIT PHON 3(p0 - ��}-O�I3�✓ <br /> SC�Iti1E I ���Q11G�I�G� I1'14(,I�.1'S� {1 E-MAILC��unClrnc�csnru.ecm� <br /> �'�1 �ooTii�CI �f �iCIi��Cf L/20���F<<SP /��Gt'. />[�il�l� 1a�7 `18733 _s[,� �5�— <br /> CONTR.lI0EN5E N J J J C !33 <br /> E"5f)2y /15 / �SKE <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> I�PSICIei'ICe I _Electric _Gas_Other � � ��� �t1 <br /> i � � <br /> WORKDESCRIPTION /��q7ovP � �li� cr c�� C'��»JJcSi �?o��, C� pel�� .rC � � <br /> �u�Cler lu�� �i,ei1�4-� r��,s��d,llJ like Ccni���s, fion, CI '�vi �t�� a <br /> �(�S�o� e c�F �el�r�s <br /> PLUMBING MECHANICAL <br /> NO. TYI'F OF FlXTURE OR ITEM NO. TYPE OF fl7CTURE OH ITEM <br /> Toilet A/C—air handling unils <br /> �athtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water healor <br /> Kitchen sink 8 disposal Gas lireplace <br /> Dishwasher Gasrango <br /> Clothes washer Clolhes dryer <br /> Waler heatcr Rango hood <br /> Sink(sarviceNadmop/elc.) Exhaust fan <br /> Backllow prevenler Hcat pump <br /> Urinal Unit hea�cr <br /> Drinking Fountain Boiler <br /> Floordrain _ Relrigeration <br /> Greaso trap Woodslove <br /> Roof drains Other <br /> Otlier <br /> � CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritity lhat I have read and examined this applicalion and know thn same to be true and cavecL All provisions of laws and <br /> ordinaces goveming ihis type ot work will be compiied with whether specilied herein or noL Jhe granting ol a permit does no�presume <br /> to give authority to violate or cancel lhe provision of any other stale or local law repulaling consiruction or the pedormance ol <br /> consiruction.That I am authorized by the owner ol ihis prcperty to peAorm the work for wh(ch application is made and I comply with the <br /> Stat C htraclors Law 182 �RCW and 296.200 WAC. <br /> �� , , t �.1�L1.LLF ( t!N�j � rl �� / <br /> S n t�re of Owner/Con ractor/Authonzed Agcnt Date <br />