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P�RMIT APPLICATIUN G �� _06 <br /> CITY OF EVERETT PERMIT SERVICES �� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 nG�' <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org (�f 1 u U <br /> APPLICATiONS ARE ACCEPTED FROM 8 AM TO 4 PM ��� <br /> � <br /> SITE ADDRESS PARCEL TAX I.D.# ' '� 'l ' �. � �� PEl�MIT# _— � <br /> ,, �r) / '. ' 1 <br /> "lt� l ���� a�n�e2DwvE �,�, ��, �-, �!��. � �r� � C�/� � <br /> LEG�I LOTNO. BLOCK TRACT � <br /> DESC. , . '- �L 'C'_ � � � r-. - �� � 1� �,.1`�1 <br /> � OWNER ADDRESS CITY/ZIP PHONE <br /> q6�fj'' [}.,75 �54I�f73lY�'� <br /> 13RDSSARD��Av���T�tY 8i4 ��� SfiS� Ev�rzE7r 4a5�s4i�'�4 Tp-a-t <br /> TENANT NAME I CONTACT FOR PERMIT PHONE ! I / <br /> sAMr l � i�. , ��� � �� . . �-��� _ <br /> , <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# I I � � 1� %SZiD/(p <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �.\�Slat'�/l�� l,l� ��I _Eleclric _Gas�.Other � I��O�Ov <br /> WORK DESCR!"TION ' • ' <br /> , +; . � .. � ' ' � � � . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilel �i� Q A/C-air handling units <br /> � Bathtub � � Forced air syslems <br /> � Lavalory(wash basin�, � Gas piping <br /> � Shower. � Water heater <br /> J_ Kitchen sink 8 disposal ' - Gas freplace <br /> � Dishwashec � Gas range <br /> � Clothes washer ! Clolhes dryer <br /> � Water healer - ' � Range hood <br /> _J_ Sink (servicelbar/mop/elc.)-� �_ Exhaust(an ( �{, <br /> �ackflo�v prevenler _ Heat pump <br /> � Urinal _ Unil heater <br /> � Drinking Founlain _ Boiler <br /> � Floor drain Re(rigeralicn <br /> Grease lrap _ V�'oodslove <br /> � Roof drains _ Other_ <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby ceritify that I have read and examined this applicalion and know the same to be lrue and correcl All provisions of laws and <br /> ordinaces governing lhis type o(work�vill be complied wilh whelher specified herein or noL The c�ranting o(a permit does not presume <br /> to ive aulhority to violate or cancel t jprovis�on of any olher slale or local la�v regulating construction or lhe performance of <br /> nslruclion.ihal I am aulhorizedj�y the owner of this p y to perfonn the work(or�vhich application is made and I comply with the <br /> late C dra�lo�La��8.2 RGIti and�9 6.2��C� ' <br /> ,' i , / � // <br /> � alu o wnedConlraclor A i6 ' ed Agenl Date <br /> � <br /> � �'2 <br /> , �f i <br /> L__ — --- — <br />