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P�RMIT APPLIC�TION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810– F�X 425-257-8857–www.everettwa.org <br /> APPL�CATIUNS ARE ACCEPTED FROM 8 AM TO 4 PM 3 -�(j —�q <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> ��a� �;�� , a o .�� a3 - a <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. � BELCOvi2T �RtH � # �Z�Z- �8 ' 3S <br /> OWNER ADDRESS CITYIZIP PHONE <br /> / / <br /> GJli�r7L�5 [�rF�GI�%O/� /G�ZJ.L%Y5G"FS'�'�,7/��_F.�/���T �j�:J03 `f�7 35�l�.3 <br /> TENANT NAME I CONTACT FOR PERMIT PHONE 7=25 3'f P �� <br /> E-MAIL,�FjkS.J –JT.S� �� i(GS; <br /> CONTft CTOR AD RE 5 CITY2IP PHO E <br /> CONTR.LICENSE N O��£� <br /> USE OF BUILDING HEP.T SOURCE I CON�T`RACT PRICE OF WORK <br /> Eleclric _Gas�Olher � L���n <br /> S%clGc>s F�i+�Ic.Y 26s�� — 1,•�'t! <br /> WORK DESCRI?TION <br /> �EPl�//2 I�oSTS SUPPO/2T/�/G ,ExiSTi,UG .DECJc <br /> — FLUMBING MECHANICAL <br /> NO. TYPE OF FIXTUnt OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ A/C–air handling unils <br /> Balhtub _ Forced air systems <br /> Lavalory(wash basin) _ Gas pipina <br /> Shower _ Waterhealer <br /> Kilchen sink 8 disposal _ Gas lireplace <br /> Dishwasher __ Gas range <br /> Clolhes washer Clolhes dryer <br /> Waler healer _ Range hood <br /> Sink(scrvice/badmop/elc.) _ Exhaust fan <br /> Backflow preventer _ Heal pump <br /> Urinal _ Unit healer <br /> Drinkinc� Faunlain _ Boiler <br /> Floor drain _ Refrigeralion <br /> Greaso lrap _ Woodslove <br /> Roof drains _ Olher <br /> d Othcr — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify lhat I hava read and examined Ihis applicalion and know the same to be lrue and correcl. All provisions of laws and <br /> ordinaces goveminc�lhis type of work will be complied wilh whelher specilicd herein or noL The granlin9 of a permit does not presume <br /> to givo authoriry to violate or cancel lhe provision of any other state or local law regulaling construclion or the performance of <br /> conslruclion.That I am authorized by lhe owner ol this property to per(orm lhe work(or which applicalion is made and I comply�vith lhe <br /> Slate Con�ractors Law 18.27 CW and 296.200 WAC. <br /> / '�n�2 � )r7S '-� /� ' .�3 - T—a�— <br /> � nature of Own ConUact Author¢ed Ac�enl Date i I <br /> � <br />