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/ <br /> —� <br /> PERMlT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAft STREET, EVERET�, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SI'I'E ADDRESS PARCEL TAX I.D.# PERVIIT# <br /> � � I�G� 1 — 0.� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OW ER ADDRESS CITYIZIP PHONEl��,s70u•/p r <br /> � l�( ,� � OD <br /> do i n "3J S�i r���%�,�1 -P.V�/'���V,�1'°�,1�3 <br /> TE ANT NAME � I CONTACi FOR PERMIT PHONE <br /> �— <br /> E-MAIL <br /> �TR CTOR ADDRESS CITYI2�P P E <br /> CONTR.LICENSE# /�� � � , / <br /> C/ 619�1� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � � ' I /`Eic-ctic _Gas_Other � `jj��("� '��a <br /> J/��12r��2 ��i1� � i �� � . <br /> � <br /> WOR��ESCRIPTION <br /> ,.�� !''�z �v/i� 5��i,��,��.�� �,�o J� ��� c�-�fca� �o � i— <br /> r.�,��;�- �,�sf���S ✓''��j� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C–air handling unils <br /> � Bathtub _ Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> ! Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clolhes washer Clo(hes dryer <br /> Water healer Range houd <br /> Sink(service/badmop/elc.) Exhaust fan <br /> Dackflow preventer Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> i _ Roof drains _ Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerlify that I have read and examined lhis application and know Gie same to be true and wrrecL All provisions of laws and I <br /> ordinances goveming this lype of work will 6e complied with wheiher specified herein or not.The granling of a permit does not presume <br /> lo give authority lo violate or cancel Ihe provision of any other state or�ocal law regulating construction or the performance of <br /> construction�Th t I am authoriz�d by tl�e owner of ihis property to perform the work for which applicalion is made and I compiy with the <br /> Sfate Conlr ct s Lay� 18.27/CW��nd 296.200 WAC. <br /> J -�m •/� <br /> SignatWe of Ow n ra o thorized Agent Date <br /> ��2 <br />