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RERMIT APPLICATIC�N <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 ADORESS PARCEL TAX I.D.# P RMIT p �7 <br /> 7C�,2 � G�' Yr i� , �n � �O 3{`�-i:�GY� -O J L-O/ �Z-G <br /> LEGAL L TNO. BLOCK TRACT � <br /> � ./ <br /> DESC. Z� Ci' 7� .Y JM`rtf SfI i ��;v� ILC.� � ��0 `C�Z <br /> OWNER � �,y D�RESS CITY/Z�IP PHONE <br /> 7\���) %�/V :�J�" �.c 6G! �roZ Lyn�l.tlrt'J� ycT »�" 9f f'S/ <br /> � ll✓c ����i•.at J.-�.,c / __9�f')6 _ <br /> TENANTNAME � CONTACTFORPERMIT PHONE <br /> � � • ��k, f� � � yzr ��zZ �r�r- <br /> ;ti ' : ea rc�r'c . � <br /> CONTRACTOR � UQ �H�k.-�)r�fN ADDRtSS CISY2IP PHONE <br /> �e��° a�"��f.� w' ty�^�-•�� _, u�r �7r yrr y <br /> CONTR.LICENSE# 2� %U Z ! ���O3G � r ' <br /> P�)26ivi tEo:zGJ"� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> S�—� _Electric�Gas_Olher <br /> WORK DESCRIPTION <br /> Co„ J .YNi'� n�cv SFR �}C.s�� ��3�r <br /> id� <br /> PLUMBING � M�CHANICAL <br /> IJO. TYPE OF FIXTURE OR ITEM NO. NPE OF FI%TURE OR ITEM <br /> � Toilet A/C—air handling unils <br /> J Bathtub � Forced air systems <br /> c/ Lavatory(wash basin) � Gas piping <br /> � Shower _L Walerhealer <br /> _L Kilchen sink&disposal � Gas fireplace <br /> / Dishwasher � Gas rany� <br /> � Clolhes washer � Cblhes dryer <br /> l� Walerhealer _L Rangeh:rod <br /> � Sink(service/harimop�cic.) � Exhaust fan <br /> Backflow prevenle� Heat pump <br /> Unnal Unit heater <br /> Drinking Fountein _ Boiler <br /> _ Floor drain _ Refrigeralion � <br /> Grease trep Woodstove <br /> Roofdrains Ulhcr__ <br /> _ Olher ✓� _ _ . <br /> — —I — <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby cerili(y that I have read and examined Its applicalion and know ihe sam��to be irue and correcL All provisiors of laws and <br /> ordinaces goveming this typo of��vrk��ill he complied wilh whelher specitied herein or not.Tha granling ol a permit does nol presume <br /> to give authority lo violale or cancel the pr�vision of any other stale or local law regulaling construclion or 1he;�erformance of <br /> cunslruction.That 1 am aulhorized by the owner ot this property lo pedorm the work for which applicalion is mads and I comply wilh lhe <br /> Stat Conlractors La��.j f3.27 RCW a�2'JG200 WAC. <br /> �.7''����J�.-� /�//G/a1- 't(�J <br /> Sign ture of OwnedContractor/Authonzed Agent � / Date <br /> -- � S� �Z��q /�ZC%3 <br />