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r �PERMIT APPLICATION <br /> CITY QF EVERET�' PERMIT SERVICES <br /> 3200 CEDAR STREET, FVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 -www.everetiwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -7 _ �-�Q� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> � J �'1 L�d'�1/3,�f' � JiVr � bF�'�// C�C � "C13 � <br /> LEGAL LOT NO. BLOCK TRACT C:2 SUBDIVISION# <br /> DESC. I U V� ' l� c� "� �i0� <br /> OWNER ADDRESS CITYIZIP PHOtJE <br /> I�>1-1 ��J � JJ �► `_�1 Nl'N / 3 � ! G���'1�A�r� �vF L�vf�'!� % 9�'���� <br /> TF.NANT NAME CONTACT FOR PERMIT PHONE <br /> W d"' 1 � `� M � I � � E-MAIL <br /> CONTRACTOR �� ADDRESS CITYIZIP PHONE <br /> ��Wl�t� <br /> CONTR.LICENSE N <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �\'�p' I � ` %�Eleclric _Gas_Olher � � S ci �'� b <br /> WORK DESCRIPTION <br /> � � � ,,:, �= <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. fYPE OF FIXTURE OR ITEM <br /> Toilel A/C–air handling unils <br /> Bathtub Forced air systems <br /> Lavalory (wash basin) Gas piping <br /> Shower Wa�er healer <br /> Kilchen eink 8 disposal Gas(ireplace <br /> Dishwasher Gas range <br /> Cbthes washer Clothe�dryer <br /> Water heater Ran�e hood <br /> '� Sink (scrvice/bar/mop/elcJ Cx:�ausl fan <br /> � _ BacL(low prevenler _� Heal pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Re(rigeration <br /> Grease lrap Woodstove <br /> Roo�dra?ns Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALE5 TA%CODE IS 9105 <br /> I hereby ceritify thal I have read and e�xamined fhis application and know lhe samc lo be lrue and correct All provisions o(laws and <br /> ordinaces goveming this lyps o(work will be complied wilh�vhether specilied herein or not.l he c�ranling of a permil does nul presume <br /> to give authoriry to violate or cancel lhe provision of any other stale or local law regulaling construction or the performance of <br /> � construction.Thal I am authorized by lhe owner of lhis properly to pertorm the work(or which application is ma�ie and I comply with lhe <br /> � Slale Conlracicrs L-a�v 18.27 C1^J and 2�6200 WAC. � <br /> �- - ���= `%��, , ��.��`�I� ��� �/ ° y <br /> Signa�ure of OwnertCo t ctodAut iorized Agent Dale <br /> i— <br />