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PEKMIT APPLICATIOIv <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, VVA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ���� ' L <br /> SITE ADDRESS / PARCEL TAX l.D.# P�R��/ � <br /> �- IJ L�:�T �i.i�2C�iL �!!•� /( f�• rxx��OZO! OC�-.��0'V L� <br /> LEGAL LOT NO. BLOCf. TRACT � . �/j�/z /�f �ON �-� W,(�t <br /> DESC. � IZOZ-c12CS•n[ /�GJ ��� �GS `� �_ — <br /> OWNER ' AUDRE55 � � C TY/ZIP � PHONE r <br /> �i'>'c.<1F ��<i�,Js�; �.,ic `��a:,� ����. 1J���..._.%Fl0/ 1 (Zv�.J�!5'->�/i3 <br /> TENANTNAME CONTACTFORPERMIT PHGNE <br /> CONTRACTO,/fj, /� ADDRESS CITYIZIP qf'NONE <br /> ��✓c: /�i?iE,E(S�i./Si �i-/L ��c7�i�T'.� J`�.� �.�✓4..r- �d�Clil n -, <br /> CONTR.UCENSE p ' ' � l Lr'�a����� y��S <br /> �,vErLe� 9b'/� .? t' <br /> USE OF BUIL�ING !iEAT SOURCE I CONTRACT PRICE OF WORK � <br /> �N�.`� /' � _Eleclric X Gas_Olher ����d-�- <br /> /�}?r.ric.c..q <br /> WORK DESCRIPTION <br /> /��� �J�3,� ��;�;e� ��'�2 �Z:uc��G,� <br /> PLUMBING MECHANICAL <br /> N0. NPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> .� Toilel NC-air handling unils <br /> �- Balhlub Forced air syslems <br /> T Lavalury(wash basin) _ Gas piping <br /> � Shower lValer heater <br /> / Kilchen sink&disposal � Gas fireplace <br /> � Dishwasher Gasrange <br /> / Clothes washer Clolhes �ryer <br /> -- �, y _ /; Ran e hood <br /> Laund tra S <br /> Sink(sen�icelbar/mop/elc.) � S� Exhausl(an <br /> Backflow prevenler _ Heat purr.p I <br /> � Urinal _ Unil healer � <br /> Drinkin� Fountain Boiler � <br /> Floordiain _ Re(rigeration �I <br /> �� Grease trap __ Woodslove I <br /> ' _ Other, ( <br /> Roof drains <br /> _ Other = - I <br /> � <br /> CIN OF EVERE7T LOCAL SALES TAX CODE IS 31G5 <br /> I hereby ceritify Ihat I have read and examined this appli�ation and know the same to be lrue and correcL All provisions of laws and <br /> ordinaces�overnin�this type o(work will oe complied with whelher specified herein or not.The granting o(a permit does not presume <br /> to yive authority to violale or cancel the provision of any olher slate or local law re9ulating construction or the performance of <br /> construclion.That I am authorized by Ihe owner of this property lo per(orm lhe work for which applicalion is made and I comply with the <br /> Slate Conbac ors Law 1827 RC and 296.200 WAC. <br /> I � 'r �,��J� I /[ �. � <br /> Signature of Owner/Contractor/Adthonzed Agent �//� �/Z <br /> �--- — --- _--_._._--- <br />