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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVI�CES <br /> 3200 CEDAR STREET, E`lERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8957—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 FM <br /> SITE ADDRESS PARCEL TAX I.D.# � RMIT# <br /> �( ��U Lcf��''L� Pc�� b OU-�jC1�o �O ���� 5-��� <br /> LEGAL LOT NO. 6LOCK TRACT OR SUBDIVISION# <br /> UFSC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> �i C �jt,�Eti-�� l�w, �- �.^L�1 (�oR-'u°� r3� I�.Q G��^,�oNi'>S � w/k `t�(p <br /> TENANT NAME CONTACT FOR PERMIT PHONE/,�1�._j�.'�L9j-{p7j�O <br /> Q / � (`}� '1 �� �(�, <br /> ���1 ���r S, RO`�I f� �(SJ"S� I E-MAIL��Ci'_'-��l� l'k'MPS� r- <br /> CONTRACTOR �ry��LC��? ��MC-� I ��AODRESS C,�TYIZIP � (PUHON��� <br /> � I (��k���rc-('� (�d( � � <br /> CONTR.LICENSEi.' {[�f/12�ILZ'a�/L,(� 7 �Z���� ���� <br /> t'� /K 1'� ��f V l <br /> USE OF SUILDING HEAT SOURCE • I CONTRACT PRICE OF WORK <br /> (�]L1r �l�✓ �'� /LO qoO . <br /> �P„�-�t ` _Eleclric �Gas_Other � <br /> WORK DESCRIPTION ��I�',��� �,J � � �� Zpo�-7 , <br /> �,� n���� � <br /> ������i�s ��"� �� �-`'' �'�' ��,��� , <br /> D�M o ���t n-i C ��-�i�i r - <br /> PLUMBING MECHANI, AL <br /> NO. TYPE OF FIXTl1RE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet ,_ A/C-air handling unils <br /> Bathlub _ Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Waler healer I <br /> Kilchen sink 8 disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clolhes washer � ) - _ Clolhes dryer��/� <br /> Waten c�aler " /"�� _ Range hood <br /> Sink (servicelbar/mop/etc.) _ Exhaust fan <br /> Backflow prevenler _ Heat pump <br /> Urinal _ Unil heater <br /> Drinking Fountain _ 6oiler <br /> Floor drain _ Re(rigeration <br /> Grease trap _ Woodslove <br /> Roo(drains _ Other <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> I hereby cerilify Ihal I have read and examined lhis application and know lhe same to be true and correcl All provisions of la�vs and <br /> ordinaces goveming lhis rype o(work will be cnmplied with whether specitied herein or noL The granting of a permil does not presume <br /> to give authority to violate or cancel the provision of any other state or local lav;regWating construclion or Ihe per(ormance of <br /> construclio . T,al I am a horized by lhe owner of lhis property to peAorm the work for which application is made and I comply wilh the , <br /> Slale Co r r.t r Law 1 7 RCW and 296.200 WAC. � <br /> , 9� J� �C <br /> Siynature df nedCon ct dAulhorized Agent ate �/Z <br /> L_ _- - - ---- - --- — - <br />