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� <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEf?AR STREET, EVERETT, WA 98201 6_ 6-�� <br /> 425•257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � (J•�U� (�;1� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> aUo9 m���r�e�v� �C�uz�.c.C� o�s 'Svoa��oioo �: <br /> LEGA LOT NO. BLOCK TFAC OR SUBDIVISI N p <br /> o�s�. a sJ�f/- a� i 30� <br /> OWNER AODBESS C'TY/ZIP PMONE <br /> 1a�� Ce-✓� �2H i �o ► �, �� Ave ��� , �►��I��nvu�('� wV1 C���)�-02�4 <br /> TENAN NAME CONTACT FOR PERMIT PHONE , . ��/ � <br /> • ��,�y� ��Zu4i c�%/-- 3yJ <br /> ��I�CCC G� W �� E•MAIL <br /> CONTflACTOR � ADDRtSS CITY2IP PHONE <br /> C�;ry4- (,�►'�`�fi't,c C�-+�� �y i �v 13l �- H,�� Sf"�,sY1d�tn'�zt S'Gi `'>P�-`l�c <br /> CONTR.LICENSE p ,,O�Y� � ��V� n� /u0.� 1 L1�� _ � ��L/ <br /> � I U T f / / ! r <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> -��- �r �Electric _Gas_Other <br /> WORK DESCRIPTION 1 ,...��t, <br /> f,�l��'�� t �� <br /> , �; , :r�� , <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> � Toilet A/C-au handling units <br /> 7 BatMub / Forced air systems <br /> \� Lavatory(wash basin) � Gas piping <br /> Shower L 'Neter heater <br /> / itchen sink&disposal Gas lireplace <br /> � Di washer �LA ,as range <br /> 1 Clol washer � C es dryer <br /> � Water h ter / Rar.c� ood <br /> _ Sink(servi ar/mopletc.) Z [xhaust <br /> Backflow preve r _ Heat pump <br /> �__ Urinal Unit heater <br /> Drinking Founlain �'� Boiler <br /> Floor drain _L Relrigeration <br /> Grease trap . _ Woodstove � <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> ,.I hemby ceritify that I have read and examined Ihis applicalion and know the same to be true and correct. All provisions ol laws and <br /> ord�naces c�overning this typc of work will be complied�vith whether specilied harein or nol.The granling oi a permit does not presume <br /> to c�ive authorily to violale or cancel Ihe provision of any other state or local law regulating construction or the performance ol <br /> cons tion. hat I am aulhorized by ihe vner ol this property to perform the work lor which application is made and I comply wiih the <br /> S e Contra or Law 1627 RC 'an �2�AC. <br /> / ; � v� � � UO <br /> Sic�nature of OwnerlCont tor/Aulhorized Agenl � D le I I <br /> i Z <br />