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PcRIVtIT APPLICATION <br /> CITY OF EVERETT PERMIT SERViCES <br /> 3200 CEDAR STREET, EVERETf, WA 9f320i <br /> II 425-257-8810- FAX 425-257 8857 -www.everettwa.ora <br /> IAPPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> �, SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> � � 3 � � ,��ks�-� z:� � �a�� c;� a <br /> � <br /> iLEGnI LOi NO. BLOCK TRAC7 OR SUBDIVISION# <br /> UESC. <br /> I OWNER ADDRESS CITY2IP PHONE <br /> I ^ �j q /J �– <br /> I ���C �l��i/' / � /�/� f r� � l L / T�/CSd� ��'�– /U�,�ZC"� 4G�'S � J7�U–} `� L � <br /> TENANT NAME CONTACT FOR PERM:f PHONE <br /> E-MAIL I <br /> CONTRACT R ADDRESS y.�- CITY2IP PHONE /� <br /> ��/;,</��^ 5�7/> l�5,,-�,: �_ L ��c� � /_.'L,�.ti�l ,�–C y-L.S– � ��- G�!u / I <br /> CONTR.LICE SE i! <br /> L 4'!-�9/��SS Oif z/l Z- ��� `I b'%o/ <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> I ' < ' <br /> /{� S �,Eleclric _Gas_Other � ' f�Q � <br /> / <br /> WORK DESCRIPTION � � .J- ,�� � <br /> ��/��t d. ,�rffi^��. ��rrv14�� G✓� /Li /7"G; O>t�J O <br /> I / _ .. _ . <br /> I PLUMBING MECHANICAL I <br /> iNO. TYPE OP FIXTURE OR ITEM N0. TYPE OF FIXTURL'OR ITEM <br /> Toilet AIC–air handling units I <br /> 6athtub _ Forced air systems <br /> Lavalory (wash 6asin) _ Gas piping <br /> I Shower _ Waler healer <br /> i� Kitchen sink 8 disposal _ Gas(ireplace <br /> Dishwasher Gasrange <br /> � — Clothes dryer <br /> Clothes washer — <br /> Water heater _ Range hood � <br />_� II _ Sink(service/badmop/etc.) Exhausl fan <br /> I — Backflow preventer � Heal pump <br /> + Urinal __ Unit healer <br /> � Drinkinc� Foontain . _ Boiler <br /> I � _ Floor drain , _ Re(ri�erelion <br /> Grease Irap , . _ Woodstove <br /> Roof drains . _ Olher <br /> ,� Other . -- — <br /> ICITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify lhat I have read and examined this application a�id know the same to be truo and correcl All provisions of laws and <br /> � ordinaces goveming this type of work will be complied with whether speci6ed herein or noL The granling of a permit does nol presume <br /> to give authoriry ro violate or cancel the provision of any other stale or local 12w regulatlng conslruclion or lhe periormance o( <br /> Iconstruction.That I am aulhorized by ihe owner of this property lo perform Ihe work for which applicalion is made and I comply wilh the � <br /> Sta�e Contracio[s L:�w 16.2 -RCW anci 296 200 WAC. I <br /> /���' � � � 7- 7_/ Z , <br /> � ��1� <br /> SignaWre of OwnedContraclodAuthor¢ed A9ent Dale <br /> I <br />