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f t <br /> PERMIT APPLICATIOR� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8657—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITEADDRESS � <br /> PARCEL TAX I.D.!t PERMIT M <br /> .�i,��� �;.i,�z�n A�1� /-`L'�� � �� 1 ,` <br /> LEGAL LOT N9 BLOCK -�••� 7 - V� <br /> DESC. �'"��3»�j����'� ��TOR$UB IVISION 5`� ��7 <br /> EVcc A ocK �-"i' "-IY- �Qi - �c� �.: -��a<.K —� 3� <br /> OWNEH -� � „�._l <br /> � ADDRESS CITY2IP PHONE <br /> �R. h'e n cLl cj, 1�n.ti,,�, <br /> 3i,��? �1F2}�n Pr�� L��.�1e� ,��A y,�5- �S�- db5� <br /> �NAN`NAME CONTACTFORPERMIT PHONE �?Of• � ,_3`J(V- �-/ D� <br /> j I l+.�rr)��CF} (3 �i��/u�'�tcn�� I f��' ,�ct1E <br /> e�a� <br /> Sa�cl[ i�9��c'/.�cu:sca.( �1cr, �r>>(�::wzc l� dc�''"ti '�?y3 <br /> CON7Fi.LICENSE# �= CU�'^ <br /> �t�m.� �j�sor ���,�°� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �l�"�i��� ��S��U� �Electric _Gas_Other �� �p��, �7� <br /> WORK DESCRIPTION 1 � J� / � /� _/� [ <br /> �J .�.tZ/� ��,� ,(:C//.l. .q�� ��(f/�? %/` �Z'T GG/��Ci [�1.'J� <br /> lZl'L /7s�/, � � �� L <br /> C ��2. v <br /> PLUMBING MECHANICAL <br /> NO. TYpE OF FIXNRE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Batlht b A/C-air handling units <br /> _ Lavatory(vrash basin) � Forced air systems <br /> _ Shower _ Gas piping <br /> _ Krtchen sink 8 disposal — Water heater <br /> _ Dishwasher _ Gas fireplace <br /> Clothes washer _ Gas rangn <br /> _ Water heater _ Clothes dryar <br /> _ Sink(servicelbar/mop/etc.) — Range hood � <br /> _ BackBowpreventer Exhaustfan <br /> _ Urinal � Heat pump <br /> _ Drinking Fountain _ Unit heater <br /> Floordrain _ Bofler <br /> _ Grease trap _ Refngeration <br /> _ Roof drains _ Woodstove <br /> _ Other _ Other <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> I hereby certify that I have read and ezamined this application and know the same to be We and correct. All provisions of laws and <br /> ordinances goveming this type of work will be complied with whether specified herein or not The granting of a permit does not presume <br /> to give authonty to vlolate or cancel the provision of any other state or�ocai law regulating consVuction or the performance of <br /> construction.That I am authorized by the owner of this property to perform the�wrk for which application is made and I comply vnth the <br /> Shate Contracto taw 8�27 RCW 6/.y�,/.,�0 WAC. <br /> � i l 7 / .Z/ wl � �'���C/ ( C �/C� l/V <br /> �a �, ..,,��,,,,,wr�nuu,anzea Hgen[ �3iB <br />