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i <br /> F ;RMIT APPLICATI�..N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STR�ET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> � b _ 63 � 05 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> ,�VEf2� ��j�� ? ��� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHOPIE <br /> �rr� � -�v�r aioi �r� r �'��zl 9g�ot 4� • 257- Seq� <br /> TENA T NAME CONTACT FOR PERMIT PHONE � <br /> C"�,�s 1.�21L 4�5 - 257- �SS�7 <br /> CONTRACTOR ADDRESS i CITY/ZIP ONE <br /> CON?4.LICENSEp ��� 'F ^ , �"�! '� ^'. <br /> � ��":'���, ��-�JJ1 l� �,��_i <br /> USE OF BUILDING HEAT SOURCE CONTRACT P CE OF WORK <br /> ��� <br /> — _Electdc �Gas_Other ,�:!�,�`.-'�. � <br /> WORK DESCRIPTION �� � �P�� � � ��� �N � �S ' v <br /> '7�/A�17" IM('�'� <br /> ,����r� ����2 �v�2 Wa� �9�ur� Ma��F��l��d,�s �o �� <br /> �rsr�� �fv9� s�=M <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITE�d NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Balhlub Forced air systems <br /> Lavalory (wash basin) Gas�iping <br /> Shower Water healer <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas renge <br /> Clothes washer Clothes dryer <br /> Laundry trey Ranc�e hood <br /> Sink(service/barlmop/etc.) Exhausl(an <br /> Backflow prevenler Heal pump <br /> Urinal Unil heater <br /> Drinking�ountain Boiler <br /> Floor drain Re(rigeralion <br /> Grease trap Woodstove <br /> Roof drains i Other <br /> Olher <br /> b i0 <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify lhat I have read and examined lhis applicalion and know lhe same to be lrue and correct. All provisions of la�v,and <br /> � ordinaces yoveming this type of work will be complied with whether specified herein or nol The granling oi a permil does not preeeme � <br /> I ' lo give authority to violate or cancel lhe provision of any other stale or local law reguiating construclion or the per(ormance of <br /> construction —ha am aut rKe�1 y/the owner of this property to perform the work for which application is made and I comply�vilh the <br /> Stale ra La _7 R ahd 296.20D IVAC. <br /> � ` , jt �j �' l�r' <br /> , <br /> S alure of 0 er/ o ctor/Aulhorized Agent ale <br /> y <br /> � _' <br />