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'rERMIT APPLICATiJN <br /> CITY OF EVERETT PERMIT SERVICE� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � lD`�� <br /> SITE ADDRESS �✓ PARCEL TAX I.D.N PERMIT# <br /> 7TV5 t�4/N/c�� t sr I " ODCn <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DES0. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> �t3fu� t,¢�-►�F�; 5/le �¢,r[ A✓E ,afUki�rEo t��- 7S¢-�z�dt <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> ��(�� E•MAIL <br /> �g� DDRE ITYIZI H <br /> M�•,BRi[L covsr• �.Sov�ec�s iNc 2�-z�3a-7i2� <br /> CONTR. LICENSE N <br /> n�i��rcR�q9.�Z. 2Z¢�tJl4�E,2�xI ��¢-nzf �j8i0� I <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK � <br /> -� Eleclric _Gas_Other ��GU�,�o <br /> WORK DESCRIPTION �t�/��J��� 6WB 6 /it/S(�LsFT/OJ �f) Ta �E B��F� <br /> W/�'lEJ���6F <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C —air handling units <br /> E3alhlub Forced air syslems <br /> Lavalory pvash basin) Gas piping <br /> Shower Water heater <br /> � Kitchen sink 8 disposal _ Gas(ireplace <br /> Cishwasher _ Gas range <br /> Clolhes washer Clothes dryer <br /> Water healer Range hood <br /> Sink (serviceNadmop/elc.) Exhaus�(an <br /> Backflow Freven�er Heat pump <br /> Urinal � Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Re(riyeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> . CITY OF EVERETT LOCAl5ALE5 TAX CODE IS J105 <br /> I hereby certify ihnt I have read and examined Ihis applicalion and know the same to be irue and correct. All provisions o(laws and <br /> ordinances governing this type o(work wdl be complied wilh whelher specified herein er nol. The granting o(a permit does�ot presume <br /> to give au�honty lo violate or cancel ihe provisien of any other state or local la�v regulating construction or the periormance of <br /> consiruclioi .i hal I am aul 0 3ed by the owner of this property�o perlorm the work for which application is made and I comply with ihe <br /> Slate G�jed s Law 1 �/f�CW and 296,200 WAC. <br /> i� <br /> ./ � „� .. <br /> , aWre ol OwnedConir odAuthorized Agent Date <br /> ��I _.--- - - ----- - --------- —I <br />