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PtRIV�IT APPLICATIUN <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 .� xU'���- � <br /> SITE ADDRESS PARCEL TAX I.D.# P MIT 1! <br /> Oo230 %r R�UG SF OO �/ BaOv��0�4. )-� -� / y, <br /> LEGAL LOT NO. BLOCK TRACT OR S/UBDIVISION# <br /> DESC. � '.�.- �/Qv�MO✓Ln,ST'. �/La5 <br /> OWNER ADDRE55 CITYIZIP PHONE <br /> 2� � s%t,�,,��- �N��S,-� t,�r yji-337- 7� �7 <br /> TENANT NAME CONTACT FOR PERMIT PHONE..�� �-- 3 j�_�/ y 7 <br /> /J /^ � / � <br /> �- l:. ��� /_.'�/ / ,2..LL�B rriTrLC✓ t'r�n•,y.o.tJ <br /> /�G n r(� v P E•MAIL i�%'e T <br /> L`�NTRAC OR ADDR SS CITY2 P O <br /> CONTR.LICENSE N <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> [leciric Gas Olhcr <br /> WORK DESCRIPTION <br /> ) . �` �„� � S7-i�v — �G�'S� �'- �:�Ji-'l�'il i <br /> �(=�NG /�;rilc�l' P C /' <br /> PLUMBING MECHANICF.L <br /> N0. TYPE OF FIXTURf OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilcl A/C-air handlint�unils <br /> Balhlub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Showcr Waler heater <br /> Kitchen sink 8 disposal Gas tireplace <br /> Dishwasher Gas range <br /> CIO�IICS N'35I1Cf Clothes dryer <br /> Water healer Range hood <br /> Sirk 'serviceNar/mop/etc.) Exhaust(an <br /> Oac�� 4ow provenler Heal pump <br /> Urin.l Unit healer <br /> Drinf,�rg Fountain Boi�er <br /> Floor drain Re(rigeralion <br /> Grease trap Woodslove <br /> Roof drains Othcr <br /> Olhar <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify Ihal I have read and eramined lhis applicalion and know the same lo he lrue and correct. All provisions o(laws and <br /> ordinaces governinc�lhis type of work will be complied wilh�vhelher specified herein or noL The granling of a permil does�ol presume <br /> lo give authority�o violale or cmicel the provision of any o�her slate or loca�law reyulaling consWclion or Ihe perlormance o( <br /> conslruclion.That I nm aulhorized by the oH�ner o(thi� �roperty to perlonn the work(or which application is made and I comply with the <br /> State Contractors La�v 18.27 RCW and 296.200 WAC <br /> _ �" <br /> Z � ' ^�>/l`—�� i�' � '71��jc� i <br /> SijnaWre ot OwnerlConiraclor/Aulhorized Agenl 'Date <br />