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'�ERM17 APPLICATfON <br /> CITY GF EVERETT PERMIT SERVICES <br /> 3�: 0 CEDAR STREET, EVERE�T, WA 98201 <br /> 425-257-8810- FAX d25-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � `"a., —Q 7 <br /> SITE AD�RESS ' PARCEL TAX I.D.# �PEORM`T�#Gl� <br /> C. I�� � �o5sa3rx�1-c�o� <br /> �ESCL LOTNO. BLQCK � A.�RSUBi�SlO�# '� <br /> �T 1 <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> �t��v'�..�\re5�1�t�R.� `�b �C 136� '(Y�O�v�U�11�E� ��Jh1 �31d}-45���5��) <br /> TENANT HF.ME CONTACT FOR PERMIT PHO�SE as-aoB-aS�+(� <br /> � `�` C.S�Y�c1CZ� �/vU-45�� -sl� l <br /> 'a.I�nC�'� E-Mni� �"li1SF. iSFh/�il���� <br /> CON7RACTOR �� �� ����S.iyuCl.,��RF.SS CITY/ZIP PHONE <br /> �N� <br /> CONTR.UCENSE L C-..�\,-,CC�I� �V� <br /> �.�y�, �r. <br /> USE OF BUILDING HEAT SOURCE- CONTR,4CT PRICE OF WORK <br /> Eleclric Gas Olher <br /> WORK DESCRIPTION <br /> ,����� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. NPE OF FIXTURE Oi?ITEM <br /> Toilel A/C-air handling unils <br /> �alhWb Forced air systems � <br /> _ Lavalory(wash basin) _ Gas piping I <br /> Shower W2ler heater <br /> Kitchen sink&disposal Gaa fireplace <br /> Dish�vasher Gas range <br /> Clothes washer Clothes dryer <br /> Water healer Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> BackOow preventer Heat pump <br /> Urinal Unil healer <br /> Drinking Fountain Boiler <br /> Floor drain Refric�eration <br /> Grease lrap Woodslove <br /> Roof dra;ns Olher _ <br /> Olher <br /> _ _ —I <br /> CIN OF EVERETf LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerili(y thal I have read and examined this application and know the same lo be tme and correcL All provisiona of laws and <br /> ordinaces governing this type of work will be complied wiUi whether specified herein or not.The granling of a permit does not presume I <br /> to c�ive aulhority to vi lale or cancel the provisi n of any other state or local law rec�ulalin9 construclion or the pedormance of <br /> conslruction.Thal I a authorized b the owner Ihis property lo perform the work(or�•�hich application is madc and I r,omply wilh Ihe <br /> ( te onlreclors L w 18.27 RCW a d 29620 AC. <br /> \. <br /> Sigha of Owned o racWdAulhorize ent �ate <br /> � <br /> \ <br /> ' — a�— - "T a„ _ =i� Zw�,�;= . - � �.: <br /> Y' . �. I R U� ���:: <br /> � �... . <br /> N• :b <br /> • , e . <br /> ..�� . . :; ; i. <br /> �. . . �. ._ , � <br /> �� . ��� <br /> �sa �..+i"r.v+-��YOM�yIi <br /> J <br /> 'y .. <br /> _ ''='2'':,.!:a <br /> :y'„�1:�'. <br /> �.> <br /> . �a.,�•,p...- � <br /> �. � � <br /> �Y�S: _ � _�. � �� �S P � <br /> iC l7i�n, e � <br /> � <br /> �¢� — <br />