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PERMIT APPLI�CATION <br /> CITY OF EVERETT ?ERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, �NA 98201 <br /> 425-257-8810- FAX 425-[57-8857-www.everettwa.or� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM (o_1 Q-O� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> �-. � � ���� t/ � S� C� �-I 3 C�C�OU 'J4i� � �C7t�SG�P-CX�Z <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESG S i ( V�Q/� C.�Z'� ( <br /> OWNER ADDRESS CITYIZIP PHONE 4 LS— 34y <br /> �T �n� U a b� l 1�Li C � L� 1 13 � y S'1- S/= F(/�,4,L n 9�i w� a a °� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> E•MAIL <br /> ONTRAC OR - ADDRESS I IZ H N <br /> Lov��II'S Cov�Sl;uc;li0v1 �aa 1 �� ��� S'1� � r �ll�lA� �lzS- <br /> CONTR.LICENSE il � `� – U L� "' U'F'^a v� � <br /> L�� S �ras?�� � �� `� / <br /> USE OF BUIL�ING HEAT SOURCE CONTRHCT PRICE OF WORK <br /> 7 <br /> �._-�,:;.� �a L__ _Eleclric _Gas_Olher <br /> ;T <br /> WORK DF.SCRIPTION <br /> _ ,%,r �, j��v �tS-� <br /> — PLUMBING MECHANICAL <br /> NO. TYPF OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel _ WC–air handlinc�unils <br /> -- �2�h�Uti _ Forced air systems <br /> lavatory(wash basin) _ Gas piping <br /> Shower Waler heater � <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gasrango <br /> Clothes washer _ Clothes dryer <br /> Walcr healer Range hood <br /> Sink(serviceibadmop/elc.) _ Exhausl 1an <br /> E3ackflow preventer _ Heal pump <br /> Urinal _ Unil he,iter I <br /> Drinking Founlain . __ Boiler <br /> Floordrain _ Refrigeralion � <br /> Grease trap _ Woodstove <br /> Roof drains _ Olher <br /> Olher — <br /> CITY OF EVERETT LOCAL SAIES TA%CODE IS 3105 <br /> I hareby ceri6(y thal I have read and examined ihis applica6on and kno�v the same to be Irue and correct. All provisions of laws and <br /> ordinacc-s govening this type of work will be complied wilh whether specified herein or not.The granling ot a permil does nof presume I <br /> lo give authoriry lo violale or cancel ihe provision of any olher slate or local la•.v regulalin�conslruclion or lhe pedormance of <br /> conslruclion.Thal I am aulhorized by lhe owner of Ihis propeny to perfonn lhe work for which application is made and I comply with Ihe <br /> Stale Contr Gtors Law 18.27 RCW and 296.200 WAC. � <br /> i <br /> � �`,��{ � �— /:) � <br /> Sig ture o(OwnedContrar,odA n�ed�eni -Dat/�� <br /> �------ ---- -_ <br />