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� <br /> PERMIT 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 7` �-0 s <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT 3 CREDIT CARDS ARE NOT ACCEPTED <br /> SI7E ADDRESS PARCEL TAX I.D.R PE�R R <br /> �s� ��'�Fic /���.���� DO/�-�'S/�%AD/z0/ I ���; r- <br /> LE�AL LOTNO. BLOCK TRACT <br /> ' DESC. �G ���J< ry' /- <br /> ONMER ADORE55 CfTY21P PHONE ys-ZSZ "vTf' (Y <br /> ��) � fj� , /� � �7�S ����J /L� /'r�/(i/�'1�it.�/ <br /> TENAHT NAME � CO✓ ACT FOR PERMR PHONE <br /> (al.G�/L ,G //�//Lr/'�/�G��ln' � b�fl,' Si��i//�i/� �/ZSzS�I ' l/DS`� <br /> coNrnn oR � ADDI�ESS cmmr PHONE��ZS'ZS��'V"I/S <br /> /a�l��a� G��nsf��cfi�� 1�ss�c. �� �;� Cv�/��"��j rIv E�.r��r�, GU� <br /> CONTR.LICENSE K ;/1� / / L G?/'7 U D j% DI� V <br /> f L L <br /> USE OF BUILDING HEA7 SOURCE CONTRACT PRICE OF WORK <br /> ������J�j/�G��{, � I _Eieclnc �Gas_Other ����r�`� _ <br /> WORK DESCRIPTION � <br /> Zhsf�zll s!c°c'z�-rs�GS�q�0 �2 0 �z�v���C� iti�r� �li�' <br /> � � �f�z�/�� � <br /> PLUMBING MECHANICAL <br /> NO. IYPE OF FlXTURE OR ITEM NO. TYPE OF FlXTURE OR fTEM <br /> Toilet _ NC-air handling units <br /> BatMub ._ Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shuwer _ Waler heater <br /> Kilchen sink&disposal _ Gas freplace <br /> Dishwasher _ Gas range <br /> Clothes washer Clothes dryer <br /> Laundry lray _ Range hood <br /> Sink(service/bar/rtwp/elc.) _ Ezhaus�fan <br /> Backflow preventer _ Heat pump <br /> Uiinal Unit hea�er <br /> Drinking Founiain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> = Roof drains I = Other <br /> Other — - <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify lhal 1 have read and ezamined lhis application and know lhe�ame lo be true and corted. All provi�ions of iaws and <br /> ordinaces goveming this rype oi work will be complied wilh whelher specified herein or not.The granting of a permit dces rwt presume <br /> to gNe authonty to violate or cancel the provision oi any other slale or local law regulaling construction or Ihe pedormance o( <br /> consWction. Thal I am authorized by the owner ol this property to perfortn the work for which application is made and I comply with the <br /> State CoMr ors Law 1827 RCW and 296200 WAC. <br /> Sign���'�'r���'�� �1���/�S <br /> of ned ontrador/Authonzed Agent � ' Dale <br /> \'Z <br />