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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> i 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.# I PERM�T]F <br /> 3c� y� •7:..� _ �� �� �q�53 ��o ': � c S��v i;� os-oo�.._ ' <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. � <br /> OWNER ADURESS CITY/ZIP PHONE �/,15"_ � �). ���j4i <br /> . 1 <br /> (j- C o,J Lt/. /`ilit< �/� 3� �/o `lucnr,� .9 �� , �'�/+roit wA 9�eto ! <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> v,�s -9�3. v��p I <br /> L 7/-� ��/C�� ,r E-MAIL _ I <br /> ONTRACTOR ADORE $ I Y21P H N <br /> CONTR.LICENSE N �f7 \ — <br /> / f� IJ <br /> USE OF BUILDING I HEAT SUURCE CONTRACT PRICE OF WORK <br /> 5��� _Electric __Gas_Olher <br /> � <br /> WORK DESCRIPTION <br /> �'� nJ ,���c /�� <br /> PLUMBING �— MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM �, .. TYPE OF FIXTURE OR ITEM <br /> Toilel _ NC -air handling units <br /> 13,+thlub _ Forced air syslems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower _ lNater heater <br /> Kifchen sink&disposal _ Gas(ireplace <br /> Dishwasher _ Gas range <br /> Clothes washer _ Clothes dryer <br /> \Naler heater _ R�� ':ood <br /> Sink(servicelbadmoplelc.) _ E..i�.:uslfan <br /> f3ack11ow prevenler _ Heal pump <br /> Urinal _ Unit heater <br /> Drinking Founlain _ Boiler <br /> I _ rloordrain _ Refrigerelion <br /> Grease lrap _ Woodstove MQ/i � �,�L�2 M <br /> Roof drains _ Olher_� <br /> Other — <br /> I <br /> CITY OF EVERFTT IOCAL SALES TA%CODE IS J105 <br /> �I I hereby ceritify ihat I have read and examined this application and know lhe same to be true and correcL All provisions ot laws and <br /> ordinaces governing Ihis�ype of work�vill be cemplied with whelher specified herein or not.The granting of a permit does not presume <br /> to give authority lo violate or cancel ihe provision ot any olher stale or local law regulaling constructiun or Ihe pedormance o( <br /> construclion.Thal I am authorized by the o�vner ol this property lo perform ihe work for which applicalion is made and I comply wilh lhe <br /> State Conlractors Law 1827 RCW and 29E.200 WAC. <br /> �_ CJ '�i vvL� ri�1� I 2ov� <br /> SiqnaWre o(Owner/ onlreclorlAuthori ed Agenl Date � <br /> -- — -- I� J <br />