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PCRMIT APPLICATIC�N <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 � "�9 /(7 <br /> SITE ADDRESS PARCEL TAX I.D.IF � PERMIT N <br /> �,r�� �,�-�-r �.� ce�-� /�8 5 `T�c►c'� r�c�2 6 ��s -a3� <br /> LEGAL LOT N0. BLOCK TRACT OR SUBDIVISION# <br /> DESC. Gj �]`-��-1 7 ,•d ,n2 n��7c�c�t� ts�0 l���ti' �O � �57 �.��� <br /> OWNER ADDRESS CITY:2!P PHONE <br /> crtl�Iz��s yt-� po��c `l,'zl cK�v u.P �'e�+/�- <br /> TENANT NA� E CONTACT FOR PERMIT PHO <br /> Uc-����r- �clu-►-'z I cE�ru�►��z aa.{ A�r�:z r ��� ��`r 7G?3 <br /> �('��[ e�na� bE�25�t14Y' l� � <br /> L�dFTftAL`Y61�� �_ 66RE`S� '/�f <br /> CONTR. LICENSEp ,�I��rl� ����L� <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �(.Ce � s TC��� ✓ E�eclric ✓Gas Olher � 7�� <br /> WORK DESCRIPTION <br /> l7lC�rUt 84S7�r�� Cras�►v1pLCIPC E�Uc�17iN�+ !N?o 2 ��!»�1�( UM� <br /> Avf� t�?—ti� -r�� fZ� �`h/�.Y l�l'u� <br /> PLUMBING — �N� MECHANICAL •— �{v� <br /> NO. TYPE OF fIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> "I'oilet NC-air handling unils <br /> Batlitub Forced air systems <br /> Lavalory (wasli basin) _ Gas piping <br /> Showcr Water heater <br /> Kilchun sink 8 disposal _ Gas fireplacc <br /> Dishwasher Gas ran�e <br /> Clothes washer C�olhes dryer <br /> Waler healer _ Ran�e hood <br /> Sink(service/�admop/elc.) Exhaust(an <br /> Backllow prevenler _ Heat pump <br /> Urinal Unil healer <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeration <br /> Greaso trap _ Woodsfovo <br /> Roo(drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7705 <br /> I hereby ceriti(y that I have read and examined this application and know the samo to be true and corroct. All provisions of lav,s and <br /> ordinaces governing lhis lype o(work will be comp�iod wilh whother specified horein or not.The granting of a permit does not presume <br /> to givo authoriry lo violate or cancel Ihe provision of any olher state or local law regulaling conslruc�ion or the performance of <br /> conslruction.Thal I am aulhorized by Ihe owner of Ihis property�o periorm the work for which application is made and I comply with lhe <br /> Sla�e tradors Law 1�.2 , W and 29G.20D WAC. <br /> �� . I �� � '� ��'S htPc� 2c+fC� <br /> Sign O��yio/Conlract /AulhQlized Ag� Date ��� <br />