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i <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8610—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT 8 CREOIT CARDS ARE NOT ACCEPTED <br /> SITEADDRESS SO�3 ��'r`< <'��' W'`� I pARCELTAXI.D.N PERMIJ# <br /> ��e��eil !;,si��n ��r, � fi2�� Ov7 ) x��Uo051o0 �'�� `� <br /> LEGAL lOTHO. BLOCK TRACT <br /> oEs�. �� i Cu� D-��� <br /> ONMER ADDRESS CITYlZIP PHONE <br /> Stev;;t� r�o��rc�_u� 503 ��r,.���e tA.b� E�uere� y�2c)s �4,Z5�355 o9y <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> ,u�,�. sr��� r����y.��e (ya5� .�5a-�iy7 � <br /> CONTRACTOR Q��,�t�^ ADURESS CITYTP PHONE <br /> CONTR.LICENSE�/ <br /> USE OF BUILDING HEAT SOURCE ( CONTRACT PRICE OF WORK <br /> � � I 7 gD0 <br /> � !';ri���f� hCJ�(1Cnc� _Elednc �Gas_Other �� J� <br /> WORK DESCRIPTON � � 1 <br /> � e .(uci,�� .5<�u'1"h �3 �er,�� o �' eA,'s1%n� �^oo (- wi�f-l� <br /> 1�Ew' Scis�or ��r�»E"7 c�r�t;� qirr.�e!' "�'✓ VS:a ���' C�u^�` = <br /> are ��,�n� ma;�C. to �1���� ��,;�'Ic�in�`�foofpr�n� O�� �I�e roc� tc���rr��)�. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet FVC—air handlinp units <br /> Bathtub Forced air systems <br /> Lavelory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(serviceibadmop/etc.) ExLsust fan <br /> Backflow prevenler Heat pump <br /> Urina� Unit heater <br /> Dnnking Fountain Boiler <br /> Floor drain Refngeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CITV OF EVERETf LOCAL SALES TN(CODE IS�105 <br /> I hereGy centify that I have read and examined this application and know the same to be true and coned. All pmvisions of laws and <br /> ordinaces goveming this type ol work will he complied witb whether spedfied herein or not.The granting of a permd does not presume <br /> to give authonty to violate or cancel ihe provision of:,ny other state or local law regulating construqion or the pedortnance uf <br /> constraclioa That I am authorized by ihe owner of ihis propertp to pedortn the work for whidi �ppliration is made and 1 comply with the <br /> State Contradors Law 18.27 RCW and 296.200 WAC. <br /> ,�� ._. , ��� � � - - , ���/��/�y G� <br /> Signature o(OwneUContradodAuth zed Agent �Date � � 1 <br />