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PERMIT APPLICATION � <br /> CIl'Y OF EVERETT PERMIT SERVICES `7 _ tq -b7 <br /> 3200 CEDAR STREET, EVERETI', WA 98201 <br /> 425-257-8610— FAX425-257-8857—www.everettwa.org _ � <br /> �—�.a_o"7 �l-2 <br /> APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM �- � �� '�- '�Z <br /> SITE ADDRES PARCEL TAX I.D.# ��� PERMIT# <br /> Z�3a� � � ' r c7oZo� �U� . <br /> LEGA LOT NO. BLOCK TRACT OR SUBOMSION# �__ . / <br /> DESC. <br /> OWNER ADORESS CIN/ZIP PHONE <br /> oP�� nwu�.C.. ��su�cu-�e� �� ������s _ <br /> TENANT NAME CONTACT FOR PERMIT PHONE�� C_^�Z�(� <br /> f ��/J�Ir`�//�.�y�/` 1 , '- (��1O <br /> �✓L�c��1 �`�d-�l� `l�J � C� l�-� E•MAIL� wl����1l�lQI LI,C4'� <br /> �ONTRACTOR • ADDRESS CITYlZIP HO E �dS2 <br /> ne� Cu�. lr� s�� D sr n� �cr c�. �� �-,zs� <br /> CONTR.LICENSE N <br /> —��m�Q�'�� OS�1_ <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> T\/�� I i _ElecUic V Gas_Olher � ^ � � , <br /> lJ.t vc� <br /> WORK D^S R'� IN � cS�lJ� v��� V`�W� 'I �� � � �`-� <br /> � <br /> �4- l'�� Gl�'�G� GI�VvU��— , <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF Fl%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> BatMub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> I = Shower = Waterheater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer _ Clothes dryer � <br /> Water heater Range hood <br /> Sink(servicelbarimop%etc.) Ezhaust fan <br /> Backflow preventer � Hea�pump <br /> Urinal Unit heater <br /> I _ Drinkint�Fountain Boiler r <br /> Floordrain '-� Relrigeration Gn0_ 1V( .SiC�c..�—�hv� <br /> � Grease Irap _ Woodstove <br /> I _ Rool drains _ Other <br /> I _ Other _ —_ <br /> i — — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> � I hereby ceritity lhat I have read and examined Ihis application and know ihe same to be irue and correct. All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whether specitied herein or not The granting ot a permd does not presume <br /> ' to give aulhority to violate or cancel Ihe provision ol any other stale or local law regulating consiruction or the pedormance o1 <br /> ; cons ction. That I authorized by the owner of Ihis property to perform the work for which application is made and I comply with the <br /> � �' onlra tors La 1 .27 RC nd 296200 WAC. <br /> ' � y �� <br /> n um of Ow e i I ctorlAuth zed Agent Dat <br /> �� Z <br />