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... <br /> �ERMIT APPLICATI�UN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 96201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM P— �g—U� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT p <br /> 3�1� a�-{-uf G-�. � oo5�s49o�3oo�W� �G�G - — <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. ,4 ; � �p3 <br /> OWNER ADORESS CITY2IP PHONE <br /> ��,m . ���, ��L�2 �� l-�.�-�.�.- 2d2 �,,,�- 9�aoi �s a�-�-�31 <br /> TENAf1�NAME CONTACTFOR�ERMIT PHONE ;�S_�5t}._V�l�{f <br /> ,_ �ce..rL �crl�.r�-ru-1�- E-MAIL [LfCI{�ILyIC.IC-�C[:MVAS�.� <br /> NTR _. ._R n!1 �",L� ADDR S� �.X I I d l I /Z p� <br /> K1_ �..�LS�:Y-iy� (/J� U.��� <br /> CONTR.LICENSE# �`�U�C�� � f�j_j���-d3r�O� <br /> �t� �l�'N <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ������ _Eledric ��Gas_Other " � (f� <br /> WORKDESCRIPTION ��`L�,�� � ���y�� �YS�'�jl�,�, <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. -�-� TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> � Balhtub Forced air systems <br /> �� Lavatory(wash basin) 2. Gas piping <br /> .L� Shower � Waterheater <br /> _f_ Kitchen sink&disposa{ � Gas firep�ace <br /> � Dishwasher I Gas range <br /> Clolhes washer Clolhes dryer <br /> Water heater � Range hood <br /> � Sink(servire/badmop/etc.) � Exhaust(an <br /> Backtlow preventer _ Heal pump <br /> Urinal Unit healer <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodslove <br /> Roof drains _ Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 1105 <br /> I hereby cerilify that I have read and examined lhis application and know Ihe same lo be true and correct. All provisions of laws and <br /> ordinaces c�overning Ihis type of work will be complied with whether specified herein or not.The granting of a permit does nol presume <br /> to 9ive aulhoriry lo violale or cancel lhe provision of any other slale or local law regulating construclion or the peAormance of <br /> c i55lruction at I am aulhorized by the owner of this property lo peAorm the work for which application is made and i compiy with the <br /> e Conlr clors aw 2�CW an 296.200 WAC. <br /> L � �0p� <br /> Signalure of Own r Coni�clur/Aulhorized Agenl Da e � <br /> � <br /> � <br />