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PERMIT APPLICATION � <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 S ` 5 _Q }� <br /> �125-257-8810- FAX 425-257-8857 -www.everettwa.org <br /> APPLIC.�TIONS ARE ACCEPTED FROM 8 AM 70 4 PM <br /> I SITE ADDRFSS PARCEL TAX I.D.# PERMI➢#�. ' / I <br /> '�. ��1. JA��_ Y�vC - Eil�C2ET cor� c,c�.�� �oo ) �'�C.'�� �iOy i <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION p <br /> DESC. yI I�OG ��� 00 � EMV�IS-tl.l 1EiZ(Z�1GE �\J � I <br /> OWNER P.:i0RES5 CITY2IP PHONE l,�ZS � <br /> l <br /> � � c_K �e. L �=i 3�c �Z zZ�� SRoc AJ� �� ci:�n •`�&zc ; �s � - s �S <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> v \CK1 � � �E\ ��lE (L E-IdAIL __' 'i <br /> CONTRACTOR AD�RESS qTY21P PHONF I <br /> CONTR.LICENSE 11 / �� � � � � <br /> �_ <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK 'i <br /> _Electric . ✓Gas_Other I <br /> WORK DESCRIPTION I <br /> RL� ��.1iSli '+�nScM�JT (u S, � „ _� I <br /> � �':��� /�� /'.En .� II <br /> / <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FIXTURE OR ITEM NO. NPE-OF FIXTURE OR 17EM <br /> j '_ Toilet _ A�C—air handling units I <br /> Bathlub Forced air syslems I <br /> _� Lavatory(wash basin) Gas piping <br /> Shower Water healer <br /> Kitchen sink&disposal Gas(ireplace <br /> Di;hwasher Gas renge <br /> Ctothes washer Clo�hes dryer <br /> _ Water healer Ranc�e hood <br /> _ Sink(service/bar/mop/e�c.) Z Ezhausl fan <br /> _ Backllow preveNer Heal pump <br /> ' I Urinal Unil healer I <br /> j _ Drinking Fountain Boiler I <br /> ' Floor drain Re(rigeration <br /> Grease trap Woodstove <br /> Roof drains Olher <br /> i; Olhef <br /> Ii — — — — I <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y lhal I have read and examined this application and know lhe same lo be lrue and correcL All provisions of laws and <br /> ordinaces qoverning Ihis lype of work will 6�complied with whether specified herein or not.The granling ot a permit does not presume <br /> Ito yive authority le violale or cancel Ihe provision of any o�her slale or!ocal law regulaling construction or lhe performance of I <br /> construclion. Thal I am authorized by the owner of lhis property lo perform lhe work(or which applicalion is made and I comply wilh the <br /> , Slate Conlractors Law 18.27 RCW and 296.200 WAC. <br /> � �`��, • � � . �Q,..s��-- s - s --,, e- <br /> I Sic�nalure of OwnerlContractcdAuthorized Agenl Date � <br /> �---- �- --------- .__. . — � ---- -_ __.-- - ------- ----- - - . . <br /> I <br />