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( <br /> 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 B AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# '��M���-�� <br /> �o r C � S- �'y9s <br /> LEGAL LOT NO. I��J BLOCK TRACT OR SUBDIVISION# <br /> oesc. I l � `�` ? cxb -�-N <br /> OWNER ADDRESS CITY2IP PHONE <br /> �'�d.� N� �imc►n [oga� � �'a�, 12c1��i��o3�ias� <br /> TENANT NA�.iE / CONTACT FOR PERMIT ' PHONE <br /> Q�Y� '6'1�111 � lU✓� I \.�L�U L� �/V�--�'l�� E-MAIL _ <br /> �/N C R�1 /'� (`�— / n ADDRE$S �} / � l cITYIZ HONE <br /> S\�C`� I�i�`1 lY\C �L'�C. lL"1�� ��lL� `� �W J�� �ias a�� ��53 <br /> CONTR.LICENSE# �S �{�( �yL���CI '�L'� �Q3� <br /> k.� IL� C,S�\�(1�1��1 i V� \ <br /> USE OF BUILDINC HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �� �Eleclric _Gas_Other I O�� � � <br /> � <br /> WORK DESCRIPTION '�� �e`���U ('jl-� �jU "� I'�Q�����'117 C �� / ' <br /> �v���-C�I�i y�� Y�e.c� �c�-� Q��in..�'� � �1: 15��-'�-J S�2 c��'S C.890.1 I� ) <br /> PLUMBING MECHANICAL <br /> Np, TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ NC-air handling units <br /> Balhlub _ Forced air systems <br /> _ Lavalory(wash basin) _ Gas piping <br /> Shower _ Waler heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Cishwasher _ Gasrange <br /> Clothes washer _ Gothes dryer <br /> Water healer Range hood <br /> Sink(servicelbar/mop/elc.) Exhausl fan <br /> Backflow preventer Heat pump, <br /> Urinal _ Unil healer <br /> _ Drinking Founlain _ Boiler <br /> Floor drain _ Refrigeration <br /> Grease trap _ Woodslove <br /> Roof drains _ Other <br /> Olher — <br /> CITY Of•EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby cerilify ihat I have read and examined this applicalion and know Ihe same lo be lrue and correcL All provisions of laws and <br /> ordinaces c�oveming lhis lype o(work will be complied wilh whelher specilied herein or not.The granting of a permit does nol presume <br /> to 9ive authority to violate or cancel lhe provision ot any olher stale or local law regulaling consWction or lhe performance of <br /> conslruclion.That I am authorized by the owner of lhis property lo peAorm lhe work(or�vhich applicalion is made and I comply wilh the <br /> State Contraclors Law 1827 RCW a 2Q6.200 WAC. <br /> ����� I � '�1 u `�r.,�� (,� � I� , � <br /> Si�naWre o(Own /CoTractor/Authonzed Agent �ate <br /> '�z <br />