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i ! <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98^01 <br /> 425-257-8610— FAX 425-257-8857—www.evere'.twa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM y�/3—O 9 <br /> SITE ADDRESS PARCEL TAX I.D.N RMIT R 'y� <br /> ' 0 r � /��� �� 3 D O ' c'`J'� <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION M <br /> DESC. <br /> OYI�NER ADDRESS CITY2IP PHONE ���3��� l <br /> � �a � � �sul����� Iq�� rzw-k�, �-��-„�-tf- ���a � s <br /> - , <br /> TEN T NAME CONTACT FOR PERMR C PHONE��h l��` ���y <br /> V � / / <br /> W�NC �IC�C.(1-� 4 (III�G''^ E�MNL RN�� It� 5��1� � <br /> 'J"�NC � �C�.e�1���E r <br /> CONTR.UCENSE It <br /> USE OF BUILDING pd�i M-� I HEAT SOURCE CONTRACT PRICE OF WORK <br /> i� ,�� � c�f A�, c.^� <br /> � r�� �— -I-�4��I E'7� u r� I-f- �Eleciric `�Gas_Other 11� d�'�C��- <br /> WORK DESCRIPTION ! I � ' � (� <br /> ' /7 � . '"'�� �r•�e (�c�cb rc G i-�� _1,,,� .w�(.���iy N �`�.P-""f�' . <br /> �>t�.cCC. � C��+�c v � � ' p r <br /> i // � /� � �Jf�� y <br /> �{,� � ' Ca.a..� /WZ� �2� /'v .i'�.`l�l�.l!!."�i � <br /> y�f`C� M cP��_.��CiG�I tc�•��L-. l , l � -+'xGa <br /> 'r12o� �4 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXNRE OR ITEM <br /> � Toilel _ A/C-air handling unils <br /> �_ Bathtub Forced air systems <br /> � Lavatory(wash basin) � Gas piping <br /> Shower Waler healer <br /> = Kitchen sink 8 disposal � Gas fireplace <br /> � Dishwasher Gas range <br /> Clolhes washer Clolhes dryer <br /> Waler heater Range hood <br /> SinY(service/bar/moplelc.) Exhausl tan <br /> Backflow prevenler Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain Boilor <br /> Floor drain Refrige2tion <br /> Grease irap Woodslove <br /> Roof drains Olher <br /> -- Other--- <br /> CITY OF EVERETT LOCAL SAlES TAX CODE IS 7705 <br /> I hereby ceritify lhal I hav�;read and�xamined lhis app��ca:ion and know lhe same to be true and correct. All provisions of laws and <br /> ordinaces governing Ihis rype of work will be complied with whelher specified herein or noL The granting of a permi�does not presume <br /> to give aulhority lo violate or cancel the provision of eey otner slate or local law regulating construction or lhe pedortnance ot <br /> conslruclion.That I am aulhorized by the owner ol lhis propeRy to pertorm ihe work br which applicalion is made and I comply wilh the <br /> Stale Contrect ts Law 1 :27�CJy;�rjand 2 200 N a;. <br /> --�? t L t '�% �C ��'�4`i�' / � — 7 Ci'C, <br /> SiJnalureofOwnedConlr cto�/AulhorizedAcc�di- Date � <br /> .' IZ <br />