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— � ; � <br /> PERlVIIT APPLICATION <br /> CITY OF F_VERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVE=RETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org (�—�3 �O 7 <br /> I _ APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM SE/"/-, OS=U�o <br /> SITE onpRESS � PARCEL TAX I.D.it PE l�IT t1 <br /> /�� 7 �'lGPJ1J Oa39 �ooaco�ioo , G_�ua. �scz -a� -�j� <br /> LEGAL LOTNO. BLOCK TRACT / �.�\ � /l <br /> DeSC. (ol L3� b3 -751y-F -d-�r2'St---ADD� T/ut��-�17ElPrY�I}-�f�'— ^`J� /v- U�/��j� �. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> Cl����' <br /> �Uuk. T�uEy �o�2r �LC i�Go� �H�2� 17,� .5� A1ic..cG¢r�x w� �2s •357- 6�8� <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> �N/I�ILES MD�G�I/-� �2J`- 353-e28ag <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CON1�R.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> r�-� i <br /> S�N��t I'/inr��y /��JNFI om� _Electric � Gas_Other i�,� rn d <br /> WORKDESCRIPTION �d�.�reLCf /S S/NG�-E FAmicY �owN��sS ^ C.�j}u� l� <br /> �s� c, �oum haus� d�J��x, - 7Y/x: _� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilet K� A/C-air handling units <br /> 1 Bathtub � Forced air systems <br /> � Lavalcry(wash basin) 9 't< Gas piping <br /> Shower � Water heater <br /> �_ Kilchen sink&disposal � Gas fireplace <br /> / Dishwasher _� Gas range <br /> �_ Clothes washer / Clothes dryer <br /> Laundry Iray � Range hood <br /> _ Sink(servicefbarlmop/etc.) g_ c� Exhaust fan <br /> �ackflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> _ f-loor drain Re/rigeralion <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby cerilify that I have read and examined this application and know the some to be true and cortect. AII provisions of laws and <br /> ordinaces governing ihis type of work will be complied with whelher specified heren:or noL The granting of a permit does not prrsume <br /> to give authority to violale or cancel the provision of any other state or local law regulating conslruction or the periormance of <br /> construc.iion.Thal I am aulhorized by the owner of ihis property to perform ihe work for which application is made and I comply with Ihe <br /> Slate Conlractors Law 18.27 RCW and 296.200 bVAC. ' <br /> G� s" � � �P,z o� <br /> Signalure of OwnedContr or/Authorized Agent Date <br /> IZ <br />