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� — i <br /> �— <br /> �ERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 ,��v 905-27 <br /> 425-257-8810- FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ��-�7�Q� <br /> SITE ADDRESS PARCEL TAX I.D.X �I�ily!.�1C'I PERM�,T# r <br /> %C�� � ' 11 l�il 'Ir�6i%�'1'..r�' 2`I �i-�iG'Z-'z2'� �'Q7'�� <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION N �j ,/ <br /> DESC. � � v�.� � N�//1 /����1��/�� <br /> OWNER ADDRESS CITY2IP PHONE <br /> �� � �i{/C'1� Pv�IC�jJ,'� �G'!'L'// A%�,�J ( , �!' `�"��� <br /> TENANTNAME I CO A FORPENMIT PHONE <br /> �� `'� �✓����lf �������/ h c9�s2�a�i�, <br /> G �/ /f7'� !/rCt- �!'� e.Ma��(a.n� 2�l��rJi�.E'� e,�. <br /> r; <br /> CONTR.LICENSE N <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> vIr/(f�'/�'/Z////i4'�A/r��G/I�/1G� _Electric �Gas_Other �Lf �'//���� <br /> WORK DESCRIPTION <br /> �i�r�rlc"l�� �� �X/s�i� /i�G Ex�,l�(�� u��i��i� ��a�+-ro� <br /> /YJCCl/PllrfT/c�'I� �I<��� !�'/1 llcfcl<�°� � ����/� �w` �/ <br /> �' U -C?O �_ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR REM NO. TYPE OF FlXTURE OR ITEM <br /> Toilet A/C—air handling uni�s <br /> Bathtub Forced a�r systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washor Clothes dryer <br /> Walen c�aler Range hood <br /> Sink(service/barlmop/elc.) Ezhaust lan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Relrigeration <br /> Grease trap Woodstove <br /> Roof drains O�her <br /> Other <br /> CITY OF EVEHETf LOCAL SALES TAX WUE!S 310.5 <br /> I hereby cerilify that I have read and examined this application and know the same to be Irue and correct. Alt provisions of taws and <br /> ordinaces governing this lype of work will be complied wilh whether specified herein or not.The granting ol a permit does not presume <br /> to give a M rity to violate or cancel the provision of any other state or local law regulating construction or the pertormance o( <br /> conslr tio 7hat I am authorized by the owner o(this property ta pertorm the work for which application is made and I compty with Ihe <br /> State ra w 18.27 nd 96200 WAC. <br /> y �/ <br /> � Sign ture of OwneUConlractodAuthorized Agent Date <br /> �/Z- <br />