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j PERMIT APPLICATIORI <br />� CITY OF EVERETT PERMIT SERVICES <br />I 3200 CFDAR STREET, EVERETT,'NA 98201 <br />I 425-257-C81 - FAX 425-257-8857 -www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE NOT ACCEPTED <br />SITE ADDRESS / �% ��� � PARCEL TAX I.D. # PERIV�IT�F <br />�i�i�i � i��� �%��'/�///Y/Li I I � �(- •':) ��(t�� ���%: ��i 1 �GSIG -( <br />LEGAL LOTNO. BLOCK � TRACT 4 <br />DESC. <br />NAME <br />� /�� '/� ; <br />CONTRACTOR <br />CONTR. LICENSE • � � //�n ��,-� <br />ADDR 55 . i � �rinr <br />: •• i;/,ly � -�-Yl�:. �✓ : �j/ <br />��% i' , y�. /r/;, f�'. i/� �:�' � <br />CONTACT FOR PERMIT <br />r? <br />F'�� �.-, � ��r . i <br />///�f...._ieG /�. i <br />ADDRESS �. �'7�� ,. 1 St' OITY2IP <br />� ��.�� <br />%J/ <br />PHONE <br />/ � N . <br />�L-d�� �3 3�� �����.� - � <br />� <br />USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF N'ORK I <br />��'�� _ Elednc _ Gas _ Other ' �� ��C�(�' - I <br />. <br />WORK DESCRIPTION <br />� i i <br />—� .. . �.�; �/ .7/'1 .. , '� � �/.7 %?�f�/i %� f�//'�i,'i�fJ: > � � • - -� � � '�� /.��i ��9G��7�� " I <br />/�'/t //%:.i:' ._)i/,�� �1�'��:�.j /�i/ �/�`l!�//.v��l �/ '� �.�ii, . ,i;.,.-�%: I//C.�J/�i �� <br />� �/l/// /�' - n l ;, . , �; , :I ��i/L.-1%. , <br />PLUMBING MECHANICAL i <br />NO. I TYPE OF FI;(TURE OR ITEM <br />Toilet <br />Balhtub <br />Lavatory (wash basin) <br />Shower <br />Kltchen sink � disposal <br />washer <br />, ..., . ,./ � p�l�. , <br />Urinal <br />Drinking Foun�ain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />NO. I TYPE OF FIXTURE OR ITEM <br />� NC-airhandlingunds <br />� Forcedairsystems <br />� Gas piping <br />„ Water heater <br />��y Gas fireplace <br />�/ . Gas range <br />� Clothes dryer <br />Range hood <br />Exhaustfan <br />Healpump <br />, it heater <br />c'TY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby cerility that I have read and examineo this application and know the same to be true 2nd correct. All provisions of laws and <br />ordinaces goveming this type of work will be corr�lied with whether specified herein or not. The granting of a pertnil does not presume <br />to give authonty to violate or cancel Ihe provision of any other state or local law regulating construdion or the pertormance of <br />construction. That I am authorized by the owner ot this prcperty to perfortn the work for which application is made and I comply with the <br />State Contradors Law 18.27 RCW and 296200 WAC. <br />SignaWre of OvmedContracror/Authonzed Agent Date � � <br />a ! <br />- -- ------ _. � <br />