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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810—FAX 425-257-8857—vwvw.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM �j „5,-0� <br /> SITE ADDRESS PARCEL TAX I.D.A PE IT• <br /> �0 9 ' . Do �� �o v 5'/!v <br /> LEGA LOT N0. BLOCK TRACT OR SUBDMSION• <br /> DESC. �L�—�8 � <br /> OWNER ADDRESS CITY2IP <br /> Oeaa� ���,�L�✓', �r.� /9 9�fh✓S� 99: ��r��, Gs�N,��� �.3� <br /> TEHANT NAME CONTACT FOR PE R PHONE C�ZS� 2 S2 • 2�5.3 <br /> ��';� / �Z��t,J ELG rn�(5+"f/ttCnf �� <br /> /(//�'�t� �/��LL� � (�1Kin�p� rf�%H E�N1AllRY'�^��tS�P.HJ�KWSOA� <br /> z�bNT1�A �ou,t <br /> CONTR.LICENSE B <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ��� � ��, ����� ��� _Eledric�Gas_Other �.�QOO �-- <br /> WORK DESCRIPTION <br /> �E'ltitadcL ��o��f�tC, a-Ocs. ���t/E �3n S frnl� Da�� ��1'/J6. �ic��-iAtic_ <br /> N�z,l G�ll�II.�JLl.��, �D'� C:'rOd��` cSIbNE�.J.�,�,�cdr C,�oP�' r�o �a <br /> PLUMBING MECHAN CAL <br /> NO. TYPE OF FIXTURE OR IiEM NO. 7YPE OF FIXTURE Olt ITEM <br /> Toilel A/C—air handling units <br /> Bathlub Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Showcr Water heater <br /> Kilchen sink&disposal Gas flreplace <br /> Dishwasher Gas range <br /> Cblhes washer Clothes dryer <br /> Water healer Range hood <br /> Sink(servicelbarlmoplelc.) Exhaust tan <br /> Backflow preventer Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeralion <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS�705 <br /> I hureby ceritify lhat I have read and examined this application and know the same to be lrue and correct. All provisions of laws and <br /> orclinaces governing this lype of work will be complied with whether specified herein or not.The granting oi a permil does not presume <br /> to give authoriry to violalc�or can the provision o(any olher slate or local law regulating conslruction ur the perfortnance o( <br /> constructio al I am author' 7j owner of t ' operty to peAorm the work for which application(s made and I comply wilh the <br /> ) <br /> Stale C hha ors Law 1E.27 C nd0,�96.200 C <br /> � .(Li / 7 <br /> Sig t o O nedContractor/Authorize c7 nt D e <br /> %z <br />