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P���MIT APPLICATIG . J <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 6 AM TO 4 PM g (oc}-, _o� �i <br /> SITE ADDRESS 7 z� Y �=�L �'r"'J%FL �I� PARCEL TAX I.D.# PER IT 11 <br /> �z-�-T. e � !�r'' 9�1�Zc,� �r. 3��t ��c-,cosrot: � � —� <br /> LEGAL LOT NO. BLOCK TRACTp OR SUBD/�IVISION N <br /> DESC. �!SS � ��� �- I �OU I7L�� 1 ��K If'� ��n <br /> OWNER ADDRESS CI YIZIP PHONE <br /> � _ �E'L•'�i�./ 7�1`/ UG/lt���/_C �,� ,�Z�C�'E�G✓� /�'�aC"� <br /> , S <br /> TENANT NAME CONTACT FOR PERMIT PHONENz��3�3 �CS{I> <br /> /� /=-L����I��/�-�1..� E-MAII <br /> q p D I 21 <br /> i <br /> CONTR.LICENSE k OL����L� <br /> L <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Cr 9 / —� Eleclric Gas Olher <br /> '!'�/��7�' L� — — — <br /> WORK DESCRIPTION <br /> /Ilc',F/4–l�l� � <br /> l�/'/;-�� �- ,��� C,�t,�'�L��- � <br /> PLUMBING MECHANICAL � <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM I <br /> I <br /> Toilet A/C -air handling units <br /> BathWb Forced ah systems <br /> Lavatory (wash basin) _ Gas piping <br /> Shower Waler hea�er <br /> Kitchen sink &disposal Gas hreplace <br /> Dishwasher Gasrange <br /> Clo�hes washer Clolnes dryer � <br /> Water heater Range hood <br /> Sink(service/badmop/etc.) Exhausl fan <br /> Backllow preventer Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain _ 6oiler <br /> Floor drain Reingeration <br /> Grease irap Woodslove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby certi(y lhat I have read and examineC ihis application and know the same to be true and correcL All provisions of laws and <br /> ordinances governing this type of work will be complied with wheUier specified herein or not.The granting of a permit does not presume <br /> �o give auUiorily�o viola�e or cancel�he"�rovisi �5 of any other state or local law regulating cunstructio�or the performance of <br /> conslruclio�.�ihal I am authorized�by�"e o�v r of�his property lo periorm ihe work for which application is made and I comply with the <br /> State Co�(rac�ors La�v 182 F d29 �0\NAC. <br /> /t� `i .� ,�C 'i . �/ ;� ._�_.� �/�!' -/� <br /> Signa�ure of Owner ontrac or�Aulionzed Agent Dale � II <br /> L <br /> �— --- - - --------- -- --� <br />