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<br /> � PERMIT APPLICATIUN
<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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 5'-a8"'��
<br /> SITE ADDRESS �[°��rc� � `�' �R? ^'1 pARCEL TAX I.D.# PERMIT Y
<br /> 1 Dl �n r . �(li t_f/ `=�;IE. . Ob�(o ?�2�i 0 .�DD � ��- ���
<br /> LEGA LOT NO. ,t �LOCK TRACT OR SUBDIVISION#
<br /> DESC. �,- "���, ' I b�' })'D( / � }11 l�b �l
<br /> OWNER ADDflESS CITY2IP PHONE
<br /> � ' �� ' i �.ol �o �� 1�2i�,r�� , -�Ue�u��4�� , l� �'� ;����:�! % L-;i� �;�g_ - - -,
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<br /> TENANT NAME CONTACT FOR PERMIT ,PHONE
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<br /> !�!f't..i) `, �1�,,Iy..3C)�..� E•MAIL
<br /> C CTO 0 RES CIT / I
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<br /> CONTR.IICENSE p
<br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK
<br /> i�/ .
<br /> �j'i ' = 11Y�'���� I r\�L�I�jf�d 'YL yElectric _Gas_Other rt�i�.,��...',� . .
<br /> WORK DESCRIPTION � �_ ,,� . . ,o,..o�.s�i` . �::r-:�,.�_r, �4.;,, ,_
<br /> � ' � • ` . . , ._ - . . . . , - .. � . . �,; _�_
<br /> II-rF-� 'n4� r%;I �i��.�L='�'.D1.1 '. ^:P '��� C �� 1� - i � ) ;'.., 1 ��.; ,. i ' i ,i.��f.�_L�
<br /> t, i� �; -�,�,-,• ' 'C�f�'t nC.A'i,-ri :F,'�li -f-t , S; ':.1F'i,,.l !.� i (. , ���� � . i'�1�:•J
<br /> ,�, �_� .., . , . , � , , ��^ +� n'., ,. �. ..SY (n 1-UR j
<br /> PLUMBING MECHANICAL
<br /> NO. TYPE OF FI%TURE JR ITEM NO. I TYPE OF FIXTURE OR ITEM
<br /> _�
<br /> Toilet _ �'C-air handling units
<br /> 3i _ BatMub Porced air syslems
<br /> � Lavalory(wash basml �� Gas pip�ng
<br /> Shower _/_. Waler heater
<br /> J__ Kltchen sink R disposal /__ Gas lircplace
<br /> _/_ Dishwasher _[ Gas ranye
<br /> J_ Gothes washer I Clothes dryer
<br /> � Water heater � ��nge h�od
<br /> � Sink(service;bar'mop'e�.�.l tl Ezhausl}an
<br /> Backllow preventer � Heat pump
<br /> Urinal _ Unit heater
<br /> _ Drinking Foun�ain _ Boiler
<br /> Floordrain _ Relrigeration
<br /> Grease trap _ Woodstove
<br /> Roof drains _ Olher
<br /> Other —_ — —
<br /> i _ CITY OF EVERETT LOCAL SALES TAX COOE IS 7105
<br /> I hereby ceritify thal I have read and e��immed Ihis applicaGon and know the same to be Irue and correcL All provisions ot laws and
<br /> ordinaces goveming Ihis�ype of work�vill h�complied�wih whe�her specified herein or noL The�7ranting of a permi�does no�presume
<br /> lo give authority to violate or , ncel thr provision ol any olher state or locai law regulaling construction or ihe pedormance of
<br /> �� �on al m ionzed by me owner of this property to perlorm Uie work for which applicalion is made and 1 comply with the
<br /> i tate Co ctors�a 827 RCW and 296.200 WAC
<br /> � S� �Owner+Contraclor �uthonzed Agenl Dale ���
<br /> I � '�,I-/� y//� ����,...� � � �
<br /> � ��CiOI�. __VSIL��L:S--i!!� t� •!' G i '
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