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f y � <br /> � P'�RMIT APPL�CAI'IORJ <br /> CIT`� OF EVERETT PERMI�' SERVICES <br /> 3200 CEDAR STREET, EVERETT, 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 ADDRESS PARCEL TAX I.D.# PEJ2�IIT# <br /> > o � � r'� �,-,�/ ��-- ;�r�>n�.'c�/�% onn�� s�/oc, � 1v�4-/ 7 <br /> LEGAL LC1T O. BLOCK -jR GT � � <br /> DESC. �l % ���'��(,��Zf,L� CLf��-:�/����� ���`�� 2�0 _ <br /> 9z�- �� ( <br /> O4JNER / / A�DRESS ` CISY/ZIP ' PHONE ^ <br /> ( LV� 7 V() � / �L.C� /��iT�'IL<����/« `/`�� ' S' /?/�CGG' iT/., � 7 C�7� r <br /> � S 7/�`- l� 7 J � �• L�2- � <br /> TENANT NAME CONTA6 FOR PERMIT PHONE <br /> ,��.1J�Q P��� /C�>-�'�i2o v�'/��/ 9��� z5 v iz/Z <br /> CCNTRACTOR .�;iCpJ Z�m ADDRESS IN21P PHONE <br /> � ✓` �7 ' � i_ o <br /> y�]/- S� 3 �� �G-c'72e:� /�; , ��o- v 3,7G" <br /> CONTR.LICENSE# �� �� � <br /> � ��' �rY' �'��7 <br /> USE UF BUILDING HEAT SOURCE CONTftACT PRICE OF WORK <br /> J �. <br /> .G� � <br /> ����J�C'����.� CC.1 _Elootric �Gas_Other _ � �� ��� <br /> WORK DESCRIPTION ^ <br /> ,z��« ,���-�?V�.�� �� s�<l 6/ ,�4 �,_, �;-� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> ` Toilel A/C–airhandlingunils <br /> - ��� Dathlub,' / Porced air systems � <br /> - -f�. Lavalory�wash basin) , � . i Gas piping , <br /> � �� Shower %_ Water healer � � <br /> � Kitchen sink 8 disposal � >�� Gas fireplace / <br /> � Dishwasher /—C' Gas ranye <br /> P Clothes washer / L�. Cblhes dryer <br /> � Water I,eater �_ Range hood <br /> /_' SinV;(serviceNadmop/etc.) �-= Exhauslfan /!�, �; <br /> _�� Backflow prevenler C ' Heat pump <br /> '� Urinal y? Unil healer <br /> O Drinking Fountain L" Boiler <br /> �' Floor drain C' Re(rigeralion <br /> 'l Grease�rap � Woodslove <br /> � � Root drains _ Other <br /> Other — <br /> CITY OF EVcRETT LOCAL SALES TAX CODC- IS 3 i05 <br /> II hereby ceriti(y that I have read and er2mined this app!ication and know the �ame to be true and correcL All provisions of laws and <br /> I ordinases 9overning lhis-type of work will be complied wilh whether specified herein or noL The granling of a permit does nol presume <br /> to give auihority lo violate or cancel lhe arovision of any other state or local law regulaling conslruGion or the per(ormance of <br /> conslruction.That I am authorize� by Ih:owner ef this property lo perform the work tor which applicalion is made and I comply wilh lhe <br /> Slate Conlraclors L�aw 182ZRCNl.and.296200 WAC. � / �, <br /> ��! --� �' C �7 ' �(� <br /> SignaWre of Gwner�on ractodAufhorized Agent Date <br />