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t <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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 7..'�.(` �Q� <br /> SITE ADDRE33 PARCEL TAX I.D.N RMtT/ <br /> ���� G�D a� . �F38o3 �oo �oo �a - /� <br /> LEGA LOT N0. BLOCK TRACT �1� ^ t,��( ��. <br /> �v� <br /> DESC. <br /> OWNER ADDRE53 CITYRIP PHONE 33�'��Z(� <br /> , A�z.-r��.pR iA �EGRoo j 1`1lS 6Ra.�fl ,4VE �✓EtZET( t cJxl . 48Zo( <br /> TENANTNAME CONTACTFORPERMIT PHONE L�Z�— <br /> I�F�AeT GI.IFT�A�i�E�7nv�C- A3ld�/ 25�-obbl <br /> CONTRACTOR ADDRESS CITY21? VHOME <br /> 1 <br /> CONTR UCEN9E t , `/J r�� � <br /> USE OF BUILDING I — HEAT SOURCE �(Jp���, I CONTRACT PRICE OF WORK <br /> G�41QA C�c+� Eledric _Ges_Olher <br /> WORK DESCRIPTION �� �S? �cTpc��D C�RAfaE l��.� S� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FlXTURE OR ITEM <br /> Tollet AIC—air handiing unila <br /> Bathtub Foroed air systems <br /> Lavalory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplaca <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Laundry tray _ Range hood <br /> Sink(service/barlmopletc.) _ Euheust fen <br /> Beckflow preventer _ Heat pump <br /> Urinal Unil heater <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeration <br /> Grease lrap _ Woodstove <br /> Root drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALE8 TA%CODE IS.1106 <br /> I hereby ceritiy thal I have read and ezemined this applicalion and know the same to be true and mrted. All p�ovisions of lews and <br /> ordinaces goveming this type o(wodc will be complied with whether spedfied herein or not The granUng of a pertnR does not presume <br /> to give authority to violate or cancel the provision ot any alher state or local law regulating conatrudion or the perfortnance of <br /> wnslruqion.That I am authorized by ihe owner of this pioperty to periortn lhe work tor which applkation is made and I comply wilh the <br /> State fC `�radors Law 18.z7 RCW ayd 296.200 WAC. <br /> ( ,f'n.',r;�G� ,�/,f,/G%r��'' � - �.� -n (o <br /> Sgnature af OwnerlGontractor uthonzed Agenl Date , . <br /> �� <br />