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F�RMIT APP�ICATIuN <br /> CITY OF EVERETT PERMIT SERVICES I <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �.. a g �f(� <br /> SITE ADDRESS � PARCEL TAX I.D.# PERMIT# <br /> � �id l ' n/Q � <br /> . J�;.� � c�� c%'u�'� OG (cCG� ;U u J � <br /> LEGAL LOT NO. BLOCK TRAICT/OR SUBDIVISION p <br /> DESC. CJUD -OG �/v A . �e iS �v s L <br /> OWNER ADDRESS CITYIZIP �HONE475'" 7S�_z�•r <br /> �'�r-��iF � i1/�T�,S�f�� (c q 3�� s7,�u�,��€ �?�1�3�1��(( cvA j5'a� z <br /> TENANT NAME CONTACT FUR PERMIT . PHONE d z S 7S 4 "z-C�'T Z <br /> �`��l'� •S�ClJC e-Mni�srr'✓F����v�svcNC uUs� <br /> CONTRACTOR ADDRESS CITYIZIP PHONE <br /> .`�( <br /> CONTR. LICENSE d <br /> USE OF BUILDING HEAT SOURCE CUNTRACT PRICE OF 1NORK I <br /> ,`� J �L _Electric _Gas_Other I <br /> WORK DESCRIPTION <br /> �-� r.- b`�� (; <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C -air handling uni�s <br /> 6alhtub Forced air systems <br /> Lavalory pvash basin; Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace � � <br /> Dishwasher Gas range <br /> _ Clolhes washer Clo�hes dryer I <br /> Water heater Range hood . <br /> Sink (service/badmoplelc.) Exhaust fan . <br /> Oackflow prevenler Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeratior � <br /> Grease trap Woodstove <br /> Roof drains Other � <br /> Other <br /> CITY OF EVERETT LOCAL SALES TA%CO�E IS 9105 <br /> I hereby certify�ha� I have read and examined lhis applicaliun and know ihe same lo be irue and conec�. All provisions of laws and <br /> i ordinances yoveming this lype of work will be complied wilh whe�her speci(ied herein or noL The granting of a penni;does not presume <br /> . to give aulhori�y to violale or cancel Ihe provision of any olher s�ate or local law regulating conslruc�ion or the performance o� <br /> ' wnstruclioi�.Th�d I ain aulliu (��J by Ihe u�vnei ul Ihis Niupmly lu peifonn the work lor which applicalion is meJe anJ I cuinpiy vrilh lhe <br /> S�ate Coniractors Law-182 -RCW and 296200 WAC <br /> I 7_i (, ) <br /> _i )�� IA� 7C)� �L��L� <br /> Signa0.ire o wner/�onUa r A 1lptized Agent - Dale <br /> ,, <br /> �--------- � —� -----�� - --- -- --._._ . _ ._ _.. --- ------------I <br />