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P�r2MIT APPLICATIO� <br /> CITY OF EVERETT PERMIT SERVICES <br /> � 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br /> ` APPLICATIONS ARE ACCEPTEO FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> ZZ�I � �(C�� �A'1/ 00 ZS'U t �1 Of� � /ODS�� D <br /> LEGAL LOT NO. BLOCK TRACT OR SUB�IVISION tl <br /> oesc. '� � � $ 2� �+�e-�Jf�t' I�j <br /> OWNER � ADDRESS CITYIZIP PHONE <br /> �1C�S'rtZ7s'�ls(�- hn, �cMC'.�' �J��(c� �6Z�3 �(z�5 3s3°I �� <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> ,f^y��1� E-MAIL _ <br /> CONTRACTOR _ . ADDRESS CITYIZIP PHONE <br /> CONTR.LICENSE a �/i)��J <br /> V W <br /> USE OF BUILDING I � HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �iC _Electr�c /r Gas _Other <br /> WORK DESCRIPTION <br /> I b X z�t � 5�� (� S�y �d v� �,��r,'�,� ��.�,T <br /> PLUMBING MECHANICAL I <br /> NO. TYPE OF FIXTUR[OR ITEM NO. TYPE OF FIXTUR[OR ITEM <br /> 1 Toilel A/C –air handling unds I <br /> _�_ Eiathtub _L Forced air syslems <br /> � Lavalory (v+ash basm) J_ Gas piping <br /> Showcr _f_ Water healer <br /> _�_ Kdchen sink 8 disposal � � _ Gas Itreplace � � � <br /> _L pishwasher T Gas rangc <br /> Clolhes viasher ' � Glolhes drycr <br /> Water heater � � Ranye hood � <br /> Smk (servicelbaJmop/elcJ � f_xhau;l fan <br /> Backllo�v pieventcr � _ Hcal pump <br /> � �,-inal _ Und healcr <br /> Drinking Founlain _ f3oiler <br /> Floor dram _ Reingeration <br /> Greasetrap VJaodstove�'I�,� 5,�� <br /> Roo1 drams � �_ Olher <br /> Olhcr — <br /> � CITY OF[V[RETT IOCAI SALES TAX CODE IS 7105 <br /> I heieby certity that I liave read and ezamined Ihis applicatiun and kriow�he same to be Irue and correct. /11i provisions ol laws and <br /> ordinances governing Ihls type ol worh wdl be comphed wllh whether specdied herehi or nol The granUng ol a pennit does nol presume <br /> lo give authonty to violate or cancel the provlsion of any other state or local law regulating conslruclion or Ihe performance ol <br /> construclion. Ihal I am authorizeA by the owner of Ihis property lo peAorm ihe work for whith application is made and I comply wdh Ihe <br /> Stale Contraclots Law 16.T/RCW and 2962UU W�1C. <br /> ��1� . <br /> i nature of Own�Contrador/Aulhoraed A9enl Dale <br /> —� --- ___---- �—�------ --- �------------�— ----- �---��— --/�— <br />