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P�RMIT APPLICATIO�d <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810- FAX 425-257-8357-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �Z fTf —D� <br /> SITE ADDRESS PARCEL TAX I.D.q PFRMIT N <br /> (o� A �.S AJE 0043 2338 ►7 0o C 1 /l O <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION M <br /> oesc. -�-� ►-1�!- �� 33� <br /> OWNER ��2�4 ZjPV� S �3�j�,��l�.N�l�aESS QCITYIZIP PHONE <br /> � 6291n �2� 3fe1-34(0l0 <br /> S��ok\vr��s�a �� n� 5-u�-�-c �aJ - 1780�. /oSA� sc � S�d�1or��sH �Z•,n-�6�-7574- <br /> TENANT NAME CONTACTFOR PERMIT PHONE 9,zF�j�- 3(DI-3�-[Ot0 <br /> �� " � 5;•otiom�ance�,�eitate.�nJe�Jtma.�ts <br /> �,J�� a Y..Es.�S�+ 1� E-MAIL � .Co <br /> -���� W � <br /> CONTR.UCENSE N <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ]S,Electric _Gas_Other 25�C�� <br /> W��n �_�a �1 �n " <br /> ESCRIPTION WJ4'Cec� Cc�o�r. �+OCc:.r. <br /> Ne� ����, .�►��POsc��-• <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM MO. TYPE OF FI%TURE OR ITEM <br /> _� Toi�cl _ A/C-air handling unils <br /> � Oalhtub _ Forced air syslems <br /> �'� Lavalory(wash basin) ._ Gas pipinc� <br /> _(_ Shower _ Water healer <br /> � Kitchr.n sink 8 disposal _ Gas fireplace <br /> � Dishwasher Gas ranc�e <br /> � Clothes washer 1 C�olhes dryer <br /> � Water healer I Rango hood <br /> Sink(serviceNadmop/ela) � Exhaust lan <br /> �ack(low prevenler _ Heat pump <br /> Urinal Unil healer <br /> Drinking Founlain Boiler <br /> Floordrain _ Refrigeralion <br /> Grease lrap _ Woodstove <br /> Roof drains _ Olher _ <br /> Other _ — <br /> CITY OP EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerili(y Ihal I have read and examined this applicalion and know lhe same lo be Irue and correct. All provisions of laws and <br /> ordinaces goveming Uiis lype of work will be complied wilh whelher speci(ied hr:rein or nol.The granling o(a permit does nol presume <br /> to c�ive aulhoriry lo viuiate or cancel lhe provision of any olher stale or locat law regulating consWclic n or the peAormance of <br /> conslruclion.Thal I am aulhorized by lhe owner of lhis property lo periorm Ihe work for which application is made and 1 comply wilh lhe <br /> Slale Contractors w 16.2� RCW and 296.20U WAC. <br /> -l"T-o <br /> Si�e o nedConlraclodAulhorized Agonl Dale �/� <br /> ci I <br /> I-- -�---- -- - — .J <br />