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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 ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.iF PERMIT# <br /> l� /ti� A��� Sf �v��B�3oo �of3o�a , - i. <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# � <br /> DESC. � �3 Off� �-n � �, ' i3 � L � 6S <br /> OWNER ADDRESS CITYIZIP PHONE <br /> /�iP�'�P a� Z,ar�uzt ��i�y��o ���a (5�l�ve S� �w�rtJ y� a��3 S <br /> TENANT NAME CONTACT FOR PERMIT PHONE _ <br /> �_— I �G��Lr� /_' E�JIAIL <br /> CONTRACTOR A ESS I I H <br /> CONTR.LICENSE p <br /> i <br /> USE OF BUILOING HEAT SOURCE CONTRACT PRICE OF WORK. �� <br /> ,,-.,.y''� �Jl�V <br /> �/��'C��;.w.��a�� �Electric _Gas_Other ���f �j L� ��T <br /> WORK DESCRIPTION � <br /> � _:. � E,,�,�:�f /5����r��n� ��c���/ls ��r��( �.���r� ,�����G, /'nn-; . <br /> �Gs�' iyio� <br /> PLUMBING ANICAL <br /> NO. TYPE OF i IXTURE OR ITEM NO. TYPE OF FIl(TURE OR ITEM <br /> 1 Toilcl _ NC—air handling unils <br /> — d�����i�� _ Forced air sys�ems <br /> Lavalory(wash basin) _ Gas piping <br /> ' *' Shower _ Walerheater <br /> Kitchen sink&disposal _ Gas�ireplace <br /> Dishwasher _ Gas range <br /> Clothes washcr _ Clolhes dryer <br /> Walcr healer Range hood <br /> Sink(survice/badmop/elc.) � Exhaust lan <br /> Backllow prevenler _ Heal pu�np <br /> Urinal _ Unit healer <br /> Drinkin9 Fountain _ Boiler <br /> Floor drain _ Relrigeralion <br /> Greasc�rap _ Woods�ove <br /> Roof drains _ Olher <br /> Olher — <br /> . CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby ceritify Ihat I have read and examined lhis application and know ihe same lo�e true and correcl. All provisions of�aws and <br /> ordinaces governing lhis lype of work will be r.omplied wilh�vheUier specified herein er noL The granling ot a permil does nol presume <br /> to c�ive aulhonry lo violate or esncel the provision of any other slate or 1oc21 law regula'ing construction or the pedormance of <br /> construdion.Thal I am authorized by the owner of lhis property to per(orm the work for which applicalion is made and I wmply with lhe <br /> Slale Conlraclors La�v 18.27 RCW and 296.200 WAC. <br /> 1�.t.�� -s Q�.��,�n,� �' 3 0� <br /> SignaWre of OwnedConlractor/Aulhor--ize�Y�enl ate �/� <br /> _I <br />