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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPI'ED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> //�;��9 %���l— s- '�,�.1/;'3' �=c�79G3'��.c:�z; �l'c� I'Z05 —G1� <br /> LEGAL � LOT NO. BLOCK TRACT OR SUBDIVISION� , <br /> oesc. .j" l%!%c� O-o�� /'7, ri��� ��.•'�� <br /> � OWNER ADDRE55 CINILP P'�ONE <br /> L ' �/r�il ��r�'�f,f 7a��`�lf�G7„�: <br /> �!I/'/`� �C'/'(��l I/,J'�`l' � "�i'i'F S� �/!r��i� � <br /> TENANYNAME I CONTACT FOR PERMIT PHONE tii 7r ��f�i� <br /> �a.� 7i. / <br /> �.T ,��<-�a<-��t��i e.Ma� ��%-�'�'Y. - i <br /> : ��.� <br /> ('iJ^�;n,! /�%t�'�I`�/J/['d/,i.1s d/ 7/f GG �/It k 4 _'�t�l-'7 /�%'i/lT1,f.f� .>/Y.��'c•� /�����"'/3 <br /> CONTR.LICENSE�l�,LY�1r,�/1 / /n��� ` ��'r�/��f�� <br /> USE OF BUILDING I HEAT SOURCE �jPNTRACT PRICE UF WORK <br /> sF/�� Electric �Gas_Other r�,a,��1��1'�� <br /> WORKDESCRIPTION ,Q/ /J�� � �) <br /> /I! /' ! !l�.f ///'/J.1/'{% <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet _ aC—airhandlingunits <br /> Balhtub _ Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Water heater <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clothes washer _ Clothes dryer <br /> Water heater _ Range hood <br /> Sink(sernce/bar/mop/etc.) _ Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Unnal _ Unil heater <br /> Drinking Fountain _ Boiler <br /> Floordram _ ReMgeration <br /> — Woodstove <br /> _ Grease irap — Other <br /> _ Roof drains � ��. ;���/,,y�c� <br /> Other <br /> CITV OF EVERETT LOCAL SALES SAJf CODE IS 3705 <br /> I hereby certi(y that I have read and exam�ned this application and know the same to be We and correct. All provisions of laws and <br /> ordinances goveming this type o(wort:v.;ll be complied with whether specified herein or noL The granUng of a permit does not presume <br /> ro give authonry to violale or cancei the provision of any other stale or local law regulating construction or the pertormance of <br /> construction. That I am authorized by the owner ot this property to pertorm the work(or which application is made and I comply with the <br /> State Contradcrs Law 18 27 RCW and 29fi200 WAC. :� <br /> ,/'.%�?..�' . A.�.. J�i//,� <br /> / � � ' � '� Date <br /> S'ignature of wnerlContracrodAuthonzed Agent <br />