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PtRMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVIGES <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 q .- a 5-oy' <br /> SITE ADDRESS `� ,/ PARCEL TAX I.D.# �D�n J� <br /> -, � 1 / L' <br /> LEGAL LOT NO. � BI.00K TRACT OR SUBDIVISION A �� <br /> DESC. �� 1 r If ;:.'��� ���% j� � ���J� <br /> OWNER AD�RESS CITY2IP PHONE <br /> 5��`l 1/v11S1� Cc�u,�r i' �Uo� i�c��fr�2c�' /t;�s �7Js�'T �9 9��j <br /> TENANT NAME CONTACT FOR,?PERMIT PHONE C�)-S -:275 ,�g.j L <br /> �-l��-✓l� l�C�i E-MAIL �lni/tiC />c�C/��..� � � <br /> C NTRACT R CIrIC r^�/�l.c,r l�GG7./� ADDR G I IZIP �y G <br /> �� Cl0 �dYlO[.ayy S ,i,��l/C,��/y�/ -��•r <br /> CONTR.LICENSE#r,�� ,�-P,��s�;J�. �(�� �J,S�'�'6 <br /> USE OF BUILDING HEAT SOURCE � CONTRACT PRICE OF WORK <br /> ��/�� /�v % � ��' �t' � �U7fi Z'v� _Electric _Gas_Other �/U O G �� <br /> WORK DESCRIPTION <br /> �`�/�i��UGr L�.L7':L / �bs/�/,J�,x(1- � �L�i , �Ai7�G'ULr L�l.v JCOa�/vl. 2aDl�� <br /> rti��i�rcc. ��ti50Ea� � B�c����rc�r d � cm�rs I��'� �-�a��ti� ti. 6y�,c,�ti. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURc OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A�C-air handling unils <br /> 6athtub Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Shower W ater heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water healer Range hood <br /> Sink(servicelbar/mop/elc.) Exhausl(an <br /> 6acktlow preventer Heal pump <br /> Urinal Unil heater <br /> Drinkinc� foun�ain Boiler <br /> Floor drain Reirigeration <br /> Grease lrap Woodstove <br /> Rocf dreins Other _ <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS�105 <br /> I hereby ceritify that I have read and e:�amined this application and know the same to be irue and correcL All provisions of laws and <br /> ordinaces governing lhis type o(work will be complied wilh whether specified herein or noL The granting of a permit does nol presume <br /> to give authority to violale or cancel the prov�ion o(any olher slale or local law regulating construction or the periormance of <br /> conslruction.Thal I am authorized by the.owner of Ihis property to peAorm the work for wh?ch applicalion is made and I comply wilh the <br /> Stale ConUaclorS.L w�16.27 R�C. tt7236.200,YVAC. <br /> / <br /> � '�l-vtti S � � � / <br /> � Signature f Ov�nerlC��ntraclor/Auihorized Agenl Date <br />