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rERMIT APPLICATi�N <br /> CITY OF EVERETT PERMIT SERVICES � /�, <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � (�I�- " �f�/ <br /> 425-257�5810- FAX 425-257-8857 -www.everettwa.�•g <br /> �'P ��yD� �PPLICATIONS ARE ACCEPTED FROM 8 AM TO d PM �n�//_��� <br /> C��� <br /> SITE ADDRESS PARCEL TAX I.D.# PER <br /> �� r�: �z� r O ,2 UO y 0 I -] O o ` - <br /> LEGAL LOT N0. �LOCK TRACT OR SV3DIVISION# <br /> DESC. L'r 'LUeII� � � �Vi ; I� � <br /> OWNER ADDRESS CITYIZIP PHONE <br /> � 2 �� <br /> '�UUndU�Ci✓ �Cn1Ri4ar'S �•U WX �O��j hUc.�tt+ �7F}.213 `1.75•�%70 7.lY7 <br /> TENANT NAME CONTACT FOR PERMIT PHONE I�LS- v 7U " 7 z�I � <br /> 1`tiA��� �je.Ck E-MAIL S�ICIIAf PILf1Pf�-itt�.� V�(k <br /> �6NTRA�fOR �A66R� ITY21P P n +^ <br /> �,�„du,��� Co,.t r« r�,�S 1���' 3ox ,�0�13 �=�en r�- �y'�+z�3 �/.�s� �r7u- �z�/ > <br /> CONTR.1_ICENSE JI <br /> �oc�;nr� CL951Kc;� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �ti��,� �, . y��� A � �Electric _Gas_Other \� �5� UU�j <br /> / !i{Aiin..a.i- / <br /> WORKDESCRIPTION SLP�Vb "W/ <br /> �= o�StrvcT tv� �l v�,� ,- �c; � Id-� �SS <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � oilel i i _ fUG''�ir hand`nc� units <br /> �l Bathlub � ��Forc�airsyslems <br /> i(! Lavatory(wash basin) r� __ Gas ping <br /> �T Sho�ver Wa( r heater / <br /> Kilchen sink 8 disposal / G�s fireplace <br /> � pishwasl er ! as renge <br /> E' Clothes w isher / � Clothes dryer � <br /> �ti Water he ter Range hood 1 <br /> Sink (se iceNadmop/etc.) / , [nhaust fan ��� <br /> Dackflo preveNer <br /> Urina� Unit heater <br /> Drinkin Founlain Boiler <br /> Floor d �in Refrigeration <br /> Greaso trap Waodstove <br /> Roo(drains Other <br /> Other <br /> CITY OF E\'ERETT IOCAL SALES TA%CODE IS 3705 <br /> I hereby cerili(y thal I have read and examined lhis application and know Ihe same to be Irue and correcl. All provisions of laws and <br /> ordinaces governing Ihis h�pe o(work�vill be complied with whelher specified herein or noL The c�ranling of a permit does not presume <br /> lo give aulhority lo violate or cancel the provision o(any olher slate or local law regulating construction or the pedormance of <br /> wnslruclion.That I am authorized hy the'tfivner ol Ihis property lo pertorm the worA tor which applicalion is made and I comply with the <br /> S�2le Conlractors L,aw 18.27 VV a++d?96200 WAC. <br /> �.- <br /> �����-%,� 5����, �,� . <br /> Signalure o(Owne'dContractodAuthorized Agent Uate I I� <br /> l — — <br />