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PtRMiT 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 � a _ �� ._ O� <br /> SITE ADDRESS PARCEL TAX I.D.1! PERMIT# <br /> -. .�_� i���ai��� c�a5 �3 �1 ��3o � yol %i� — G'zl� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBD�VISION N <br /> DESC. I �-I �� � c"j ��,3 .>�cln�4�: r� 1�irc� C� Ac�c� � �� oV� <br /> OWNER ADDRE55 CITYIZIP PHONE <br /> (� � X � � 5�� ��Js 33 ;�3 Tu �nl � � E.�e�r-��! <br /> TENANT NAME CONTACT FOR PERMIT PHONE LIZ� 3 O 3 �S�OO <br /> ��{� TIZEbiJA�/ Co�x � I-�at��y Tr�� w�.y 4zs3y5 io �o � <br /> E•MAIL <br /> NT A T R A�DR ITYIZI PHO <br /> CONTR.LICENSE H //'�•�'/`� �"� . <br /> r <br /> USE OF BUILDING H[AT SOURCE CONTRACT PRICE OF WORK <br /> .:�1.f��-�c�=�-���CeL _[leclric _Gas_Olher ;� ������ <br /> r <br /> WORI( DESCRIPTION r���V (�'���au� � �r l.lJ�+-�Q <br /> _� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTUR[OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Todet A/C -av handling unds <br /> E3athtub . Forced air systeins <br /> Lavatory(wash basin) Gas piping <br /> Shower Waler heatar <br /> Kitchen sink&disposal Gas fireplace � <br /> Dishwasher Gas range <br /> Clolhes wash�r Clothes dryer <br /> Waler heater Range hood <br /> Sink (scrviceNadmoplcic.) . Ezhausl�an <br /> [3ackflow prevenler Heal pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Refngeralion - <br /> Greasc irap Woodstove <br /> Roof drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAx CODE IS J105 <br /> I hereby certify thal I have read and examined ihis applicaiion and know ihe same�o be lrue and correct. All piovisions oi laws and <br /> ordinances governing ihis type of work will be complied wilh whether specifed herein or not. The gran�ing of a permit does not presume <br /> lo give authori�y lo violale or cancel�he provisicn of any olher stale or local law regulaling consiruction or ihe periormance of <br /> construdion. That I am aulhorized by Uie owner of�his property lo pertorm the work for which applicalion is made and I comply with the <br /> Stale Conlractors Law 1827 RCW and 296200 WAC. <br /> c <br /> � 1� {•�.a: ��- l.i)C L�-( � �. � �� � 1 <br /> Signature o(O�v �dContractod�idhorizec�S"Agent Dale <br /> — � -� -� - -- --------------. .. ._- ------- --------�-------- --- - - .I <br />