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PERMIT A�PPLICATION � <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 �— �(�—D� <br /> SITE ADDRESS PARCEL TAX I.D.# PER��IIi ii n <br /> � Zc� ��zKe�� � �1�,= Cz�y � �to �39oi3oo ,�5�1,� l� <br /> LEGAL LOT NO. ' 1 BLO(:(K� TRACT OR SUBDIVISION p 7 / / <br /> DESC. I 3 - I`1 �� / CV�� ( ( �/�!�) �� �i �-/�!<7 <br /> OWNER ADDRcSS CITY2IP PHONE <br /> C_ �C� � / Y�i� I��G�j .�Z�' C.•�Zil�l� �U:3 � " IT /GZO ��CJ ZS��Z7 <br /> TENANT NAME CONTACT FOR PERMIT PHONE/�a� �j� ZGu14 <br /> ti-(.v1,L !V/iaJltl�(/r.Z E-MAIL <br /> R C DURFSS I I 1'HONE <br /> �2P1�- %z`RV ICi=`� n /��� � �, I <br /> CONTR.LICENSE# ``G?I�� ���I�U��I�- 1,�:� I�J �'�[L �8�3 GGL� SZ�VS7C� <br /> Nov-��S( Zi��.n <br /> USE OF BUILDIhG HEAT SOURCE COtNTRACT PRICE OF WORK <br /> j(- �Z _Electric �Gas_Other T 'y� 'f�'� 7, �C7 <br /> WORK DESCRIPTION <br /> �i_" (�"c 14� h,U"�i-r c� 4!c G-�< <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTUR[CR IT[M NO. TYPE OF FIXTURE OR ITEM <br /> Toilet NC–air handling unils <br /> 6alhtub Fcrced 2ir systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower _ N'alcr healer <br /> Kilchen sink 8 disposal _ Gas lireplace <br /> Dishwasher Gas range <br /> Clolhes washer Cblhes dryer <br /> Water healer Range hood <br /> Sink (service/bar/mop/etc.) _ Exhausl lan <br /> Back(b�v prevenler _ Heal pump <br /> Urinal Unit healer <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigera�ion <br /> Grease lrap Woodslove <br /> Roof drains Olher <br /> Other <br /> I — CITY OF EVERETT LCCAL SALES TAX CODE IS 9105 <br /> I hereUy ceritify thal I have read and examined lhis applicalion and know lhe same lo be Irue and correcL All provisions of 12ws and <br /> ordinaces goveming this lype of work will be complied with whelher speci(ied herein or nol The granting o(a permit does not presume <br /> to give aulhority lo viol2le or cancel Ihe provision of any other slate or local�aw regulaling construction or lhe periormance of <br /> ' conslruction. Thal I am aulhorir.ed by Ihe ownei of this property lo petform the work(or which application is made and I comply wilh Ihe <br /> Stale Conlrt�cl La�v 1 27 RCW and 296.200 WAC. <br /> l <br /> I —�=� Ll � c >{ ��1 � 12 nR <br /> SiynAWro of O� nedContiaclor/Authorized A�enl Date 1� <br /> --�1 <br />