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� <br /> P�RMIT 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 �� 3 —p� <br /> SITE ADDRESS PARCEL TAX I.D.N PERMIT# <br /> ��2a o ,+1F5 �1 J r oa�3 9 iG�S o� 9a� � -.��. <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. ' 4, S �0 p <br /> OWNER �q � ZO ADDRESS CITY2IP PHONE <br /> ,Lin,��S nJ. �vrize�� ��oddk �.���s C�.��i 9�f2A3 <br /> TENANT NAME � CONTACT FOR PERMIT PHON <br /> `� 1 z a �L -3�z•3�3d <br /> C���S I 1� /�D A/ �A r�IJS Cj� e.Ma� <br /> !�� T/�Sa'rTt�S� �ti�G �/i� -z2a %'��su! yl%��ic�."'�. 9SSa '�3 <br /> CONTR.UCENSE# ' ` <br /> /�11�7i9.L-,L 'l"�'t// �� Zd6^J�(oz�c3Y�' <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> d� <br /> �� r V��nJ � _Eleciric �Gas_Other /�� �O� � <br /> t�J I /Q / <br /> W^fsE/.�Rj1.lOJ To�/ /���+ r=Te/� �AS iACXAN �� i�✓ 'LTt,Jd2X� <br /> �j� r�r-1c� D��-� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling units <br /> Bathlub Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Water healer <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Ciolhes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/elc.) _ Exhaust fan <br /> BackOow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roo(drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y thal I have read and examined this applicalion and know lhe same to be lrue and wrrect. All provisions of laws and <br /> ordinaces goveminc�this type o(�vurk will be comp�ied wilh whelher specified herein or nol.The granting ot a permit does not presume <br /> to give authority to violate or cancel the provision any olher state or local law regulating conslruction or the perfortnance o( <br /> construction. fhat I am aul y the own f lhis property to perfortn the work tor which application is made and I comply with lhe <br /> S rec or w'18.27 RCW nd 29 WAC. <br /> —� - � �-��•D � <br /> Si na ure of OwnedContra Autho ' ed Agent Date <br /> ` IZ <br />