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� <br /> P�RMIT APPLICATION <br /> CITY OF EVEf2ETT PERMIT SERVICES <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 <br /> PARCEL TAX I.D.# PERMIT# <br /> SITE ADDRESS Eo�oa-oo 3 <br /> 2� -� "z � , .�f,,,<�, Di� s <br /> LEGAL LOT N0. BLOCK TRA('T OR SUBDIVISION# — <br /> UESC. CITYIZIP PHONE <br /> ADDRESS '7 <br /> I OWNER r I �ZS '�}?7— ��2( <br /> l.� il S "t � <br /> �� iL� Q `� t � J PHONE <br /> TENANT NAME I CONTACT FOR PERMIT <br /> E•MAIL <br /> ADD ESS <br /> CITYIZIP PHONE <br /> CONTRACTOR <br /> CONTR.LICENSE p O�J �1�� <br /> HEAT SOURCE I CONTRACT PRICE OF WORK <br /> USE OF BUILDING M�C I (' <br /> ./ 3 0���- <br /> � � �4 _Eleclric l�Gas_Other <br /> \ .. ` v�a.,d Z Y �'( <br /> � �a1�C« v� ��5 w � <br /> WORKDESCRIPTION �� (�c,<c �x S`iS� •, 2 x y <br /> � v C f—Z v a��S \,,,, �� `� Q 1 3 �,•�5,. t�.I � �-� <br /> MECHANICAL <br /> — PLUMBING <br /> NQ TYPE OF FIXTURE OR ITEM <br /> NQ TYPE OF FIXTURE OR ITEPd <br /> A/C—air handling unils <br /> Toilcl Forced air systems <br /> BalhWb Gas piping <br /> Lavalory(wash basin) — Water healer <br /> Shower Gas fireplace <br /> Kilchen sink&disposal Gas range <br /> Dishwasher Clothes dryer <br /> Gelhes washer Range hood <br /> Waler heater Ezhaust(an <br /> Sink(servicelbarlmoplelc.) Heal pump <br /> Backllow preventer Unil heater <br /> Urinal Boiler <br /> Drinking Fountain Relrigeralion <br /> Flaor drain W oodstove <br /> Grease trap Other_�� <br /> Root drains <br /> Olher___— <br /> -- _�_ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined lhis application and kno�v 1he same to be lrue and correct. All provisions of laws and <br /> to glive auR o iry to 9iollateYor cancel�lielprov's on oI(any lo'ther�state or�loc�al aw re�ulatin9�con,sl uction o�the�perlonnance o( nresume <br /> I conslruclion.Thal I am aulhorized by lhe owner of lhis propeny to per(orm lhe�vork tor which application is made and I comply wilh lhe <br /> Sla+e C i r rs La�v 1 i327 RCW end 296.200 W AC. 2� y /G� <br /> ����� D�[e <br /> ISignaWre of OwnedCoNraclorlAulhorized AgeN <br /> I _ <br /> �--- ---�------_ ------ <br />