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PtRMlT APPLICATIf�eV <br /> CITY OF EVERETT PERMIT SERVICES <br /> I 3200 CEDAR STREET. EVERETi, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED 'FROM 8 AM TO 4 PM <br /> SITE ADORESS PARCEL TAX I.D.# PERMIT# � <br /> I �a� F1o�T I�v� . OC4 ��C'� - �41 - 0� 3 - c�o ,�; ' � ; � ���� <br /> LEGAL LUT N9. BLOCK TRACT ' �� <br /> DESC. �=, �41 P���r nF E�(ER�.TT, b� Ulslonl � L <br /> OWNER ADDRESS CIN/ZIP PHONE <br /> }�Ai(ZICK WILLIA{�'ISoD� IF3:tF - 17'—" RVE. SE �p�iI.LC�EE � ,9� O �Z <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> i'AM (?NF�t� �A i i,�)i l� � A1�1�o►� �2oG� ���S- z2 `i z. <br /> CONTRACTOR ADDRESS CITY/ZIP PHONE <br /> CONTR.LICENSE# NOr�I� : �.�b RK DQ� � I.� l ��I" E h <br /> USF OF BUILDING HEAT SOURCE CONTRACT PRI E OF WORK <br /> J1N�'��l ���IIL� �2E.$f�iCN��� _Eleciric �Gas_Olher N �a ����1,� .�i <br /> WORKOESCRIPTION ;���F �l[NI �LTC�-AT1C'N� O h��('�`'� = I�.�INL00.1� <br /> �� [zT i't AC[ �XTCRi02 ��F��Ay ��� �Aftl-1Tlow' lti� P �C_ . <br /> =��� i_ r�TTRC�IFI) �E�CRIPl-101.� l4R�Nr /�TE�J (,�',/ r��)!Sf�Efl �I�C <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FIXTURE OR ITEM NO. TYPt OF FIXTURE OR ITEM <br /> Toilet _ A�'C-air handling units <br /> 8alhlub _ ForceJ air systems <br /> Lavalory(wash basin) _ Gas pipiny <br /> . Shower _ Water heater <br /> Kilchen sink 8 disposal _ Gas fireplace <br /> Dishwasher G2s rani7e <br /> Clolhes washer _ Clothes c�ryer <br /> Water heater _ Ranc�e hood ►�I� � � <br /> _ Sink(service/bar/moplelc.) �N� _ Exh�ust fan � " <br /> Back(low prevenler _ Heat pump <br /> I Urinal _ Unit healer <br /> _ Drinking Fountain _ Boiler <br /> Floor drain _ Re(ngeralion <br /> Grease lrap _ Woodstove <br /> Roof drains _ Other <br /> Other — — <br /> I CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> � I hereby ceriti(y lhal I have read and examined this applicalion and know the same lo be lrue and correcL All provisions of laws and <br /> ordinaces c�oveming this type ol work will be cumplied with whether specified herein or rol The graNing of a permit does not presume <br /> to c�ive authority to violale or cancel Ihe provision of any olher state or local law regulating conslruclion or the performance qf <br /> I cons(ruction.Thal I am aulhorized by the owner o(this properly to perform the work tor which appliwlion is made and I compty with the <br /> Slale Co traclors La 18.27 RCW and 296.200 WAC. <br /> , �� �l�\ , <br /> =r��4� �� ���s-�'� I <br /> Signature o(OwnedContraclor/Aulhonzed Agent Dale I <br /> I <br />