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PERM�T APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8057-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � _ � � -�� <br /> SITE ADDRESS PARCEL TAX�•�D OD �C�t���J� <br /> /ll) /l <br /> `(J-� Ti� <br /> LEGAL LO NO. 9LOCK TRACT � � / <br /> DESC. �=�j <br /> OWNER H URESS ,/� IjY�1 � C P�,H�O'NE �� <br /> � a ���delr� S� � �.�q��g� � 2�5-02$2 <br /> TENA.iT NA E � r CONTACT FOR PERMIT PHONE <br /> � �����N11�� �`���s �. ���. �g�3 <br /> CONTRACTOR /�1;11,n A�/ ��` ADDRESS CITYIZIP PHONE <br /> �d�(//Y 7 7 � �3�:3��3 <br /> CONTR.LIC,�.'-1tI�IA�G �/��l77� /U77/I/ JO�2�Y_��t—`� � UI�TI <br /> P <br /> USE Of BUILDI G HEAT SOURCE CnNTRACT PRICE OF WORK <br /> Q �� � �, `�Elec�ric Gas_Other � bD� Q � <br /> WORK DESCRIPTION �`� a Q �CP /�� r <br /> 7"�Ylan J� l/fc !h ��/S�� Qr�/�d <br /> � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYpE OF FIXTURE OR ITEM <br /> � Toilet _ A/C–air handling units <br /> BalhWb Forced air systems <br /> � Lavatory(wash basin) Gas piping <br /> Shower = Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Cishwasher Gas range <br /> _,� Clothes washer CU�thes dryer <br /> – La�indry lray R¢.nge hood <br /> Sink(service/badmop/etc.) E;.haust fan <br /> BackOow preventer _ Hcal pump <br /> � Urinal _ Uni'healer <br /> � Drinking Founlain Boiler <br /> ' Floordrain Refrigeration <br /> Grease lrap Woodstove <br /> Roof drains Olher <br /> Other _ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify tnat I have read and examined this application anA know lhe sarne to be true and correci. All provisions of Iaws and <br /> ordinaces governing�his type of work will be.omplied with whe�her specified herein or not.The granting of a permil does nol presume <br /> to grve authoriry to violate or cancel lhe provision ef any olher state or local law regulating construction or the performance of <br /> construction. That I am aulhorized by�he owner of�his property to perform the work for which application is made and I compty with the <br /> Slate C rs _2w 1827 RCV7Yand 296200 WAC. <br /> g����l1 " " / �_�U�(/F7 '�� <br /> Si natu! of vner4�orlMactor/Authorized A ent Date i � � <br /> ---- - – - - -- �-- — – – —� – -- --�–�/�— <br />