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� <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> ���ll APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � <br /> ,�I , ne ��r�.-o <br /> SITE ADDRESS PARCEL TAX I.D.# CC�.�W�S PERMIT it <br /> _� ���- , I <br /> LEGAL LOT NO. BLOCK TRACT n m�rNI�1�� <br /> DESC. r <br /> OWNER � AD�RESS CIN21P PHONE <br /> An��e &� {ti,13-�-1�I <br /> � �v� <•a.�,. a tr�r��sMe�; <br /> TENANT NAME CONTACT FOR PERMIT PNONE <br /> 7c��t�collc �1 flcSlav��-�^'� ����1�1 �1�5�� Z5i �-1-�� <br /> CONTRACTORE�yY?+������_ (,�1...�— ADDRESS CITVIZIP PNONE �� ��•�_2� <br /> lkrLiG�2�rr�r CLO ��n; C��1}z,1x�c��x, <br /> CONTR.LICENSE� {�UM/ 2�a�-r <br /> � mG QJ1FL�1� m� �ytf/1F'� <br /> USE OF BU�LDING — �HEAT 5 RCE I CONTRACT PRICE OF WORK <br /> Electdc _Gas_Other <br /> WOFjK DESCRIPTION <br /> O,eluc<<� Z�� �'rc. S���n�L���. <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FI%TURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet _ FUC—airhandlinqunits <br /> Bathtu6 _ Forced air systems <br /> Lavalory(wash basinl _ Gas piping <br /> Shower _ Water heater <br /> Kdchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gas renge <br /> Clotheswasher _ Clothesdryer <br /> Laundry lray _ Range hood <br /> = Sink(service/bar/mop/etc.) _� _ Exhaustlan <br /> Backllow preventer _ Heat pump <br /> = Unnal / _ Unit healer <br /> � Dnnking Founlain . �� _ Boiler <br /> Floordrain _ Refngeration <br /> Grease trap _ Woodstove <br /> Roof tlrains Olher <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS J105 <br /> I hereby cenfify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces 9overning this type of work will be complied with whether specifed herein or not.The granting ot a permit does not presume <br /> to give authority to violate or cancel the provision of any other slate or local law regula�ing construction or the performance o( <br /> construclioa That I am authorized by the owner of lhis property to perform ihe work for which application is made and I comply with the <br /> �S t�e�Contractors Law 1 Y7 RCW and 296.20�WAC. <br /> \`,/'Li <br /> ',/�i}=( � ) ��`:"�' �`C�s l di _ <br /> SignaNre ot wneNCoMracrorlAuthonzed Agent Date �/� <br /> I <br />