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PERMIT APP�_ICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> I� 3200 CGDAR STREET, EVERETT,WA 98201 I <br /> 425-257•8810- FAX 425-257-8857-www.everetlwa.org <br /> APPLICATIONS ARF ACCEPTED FROM 8 AM TO 4 PM /Z"���-d � <br /> I� SITE AODRESS �1 k PARCEL TAX I.D.# PERM�R 1 <br /> ��L Z. l 1' 1 7�- ��1��� �� i'. �d - ��, <br /> LEGA LOTNO. BLOCK TRACTORSl18DIVISIONA <br /> li �ESC. <br /> I OWNER ADDRESS CfTYZP PHONE '��-N f"i'� "J1 <br /> �� C c��? � Pt'r•��t1 �1 tc�t C� ���,e��� 7� ��Yc��3�'r 1,�' 4 �1�20� <br /> �, TENANTNAME CONTACTFOBPERMIT PHONE '�Lt�, � �\ `l��l l <br /> I I �.J��1 �'e- `�t�Y�.�'Z E-MAIL <br /> C�C:�Lt��1a -�r'�.-`�t 1411v\1D (�\Y`C%'��''-1 (�C��'� �j\�C��'�-����1{ <br /> ' corrrn.uceNse a /�I�:n(��..\\CIID'-�-.L T � C�' �i�S'l-L 1 <br /> i l3� �� (�r .�1--L5c=�� — <br /> USE OF BUILDING I NEAT SOURCE I CONI'RACT PRICE OF WORK <br /> II � �-� _Electdc Gas Other <br /> WORK DESCRIPTION <br /> I � . <br /> C� �� � � /� ;v/.�c� <br /> PLUMBING MEGHANICAL <br /> NO. TYPE OF Fl%NRE OR ITEM N0. TYPcOF FI%TUflE OR ITEII <br /> Toilet A%C-air hardling units <br /> Ba�htub Forced air systems <br /> Lavatory(wash basin) X Gas piping <br /> Shower Watcr heater <br /> IKitchen sink&disposal h Gas tireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothzs dyer <br /> Water heater Ranae Iwaf <br /> Sink(servicelbarlmop'etc.) Ezhaust fan <br /> Backflow preventer Heat pump <br /> � Unnal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeralion <br /> Grease trap Woodslove <br /> Iioot drains (rher _ __ <br /> Other <br /> � CITY Of EVEREI"f LOCAL SALES TA%CODE IS 3105 <br /> I hereby centily tha� I have read and e�amined ihis application and know the same to be irue and corred. All provisions ol laws and <br /> ordinaces goveming this type of vrork will be complied with whether spedlied herein or nol.The graMing of a permit does not prescme <br /> to give authority to violata or cancel he pmvision ol any other stale or Iceal law regulafin{7 construction or tho peAormence of <br /> conslruction. That I am authonzed y ihe owner of ihis pmpe�ty to pertorm ihe work 1or which application is made and I comply with the <br /> State Contractors Law 18.27 RC a 296.200 WAC. <br /> �� � � -' /J - 'J c� <br /> Signature ol OwnedConira d honzod Agent Date <br />