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PERMIT APPLICATi IC�f� <br /> C{TY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERFTT, WF� 98201 <br /> 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.# PERMIT# <br /> '��; j!��'r�1/�lV(�i � ' �Ct� (Ji� _ � z�� �rr;ol�- ✓'�' ��'��� "�l� <br /> L[G�1L LOT N0. BLOCK TRACT <br /> DESC. � <br /> OWNER ADORESS GITYIZIP PHONE <br /> `� � T� 1/�� y���i �/%rti� �^�al�e ��v'�,� ,�; 9,�a o 3 <br /> —�T CONTACT FOR ERMIT PHONE <br /> �coeurunuc <br /> / <br /> Ib��n�\ Cuun�r� Pos� I�rantc liuildin� � n i 9, �� 1 � 1i - ���� <br /> i <br /> I ' .;�LL�� ��; � (�,v'/� �l,��U� 11'U�4-5 7y_ i_ - <br /> 16„_I Ili�h��;It 99SIcC qDDRESS CIN(ZIP PNONE <br /> I.�nm�uud. AV'A 9R11;' <br /> a_'.`-7d2-169I P;i�.l]S-7.�:_IiSje�l.�-!0 � � <br /> I.ic:, �IY)11�NCPP0991.1 j�Y�J �� C , . <br /> HEAT SOURCE CONTFiACT PRICE OF WORK <br /> �i USf OF BUILDING � � <br /> � �1 ' I� �„�V' , : , <br /> ' c� � _ _ _.� 1" Electnc �"� Gas_Other ��!�� -y (G- <br /> ' � — <br /> II WORKDESCRIPTON �,�j1I✓Sc. <br /> �� � , � ; � � 1, � � ;�������� �� f��� � �.. ,s;���� _� <br /> � � <br /> ' PLUMBING MECHANICAL <br /> � Np, TYPE OF FIXTURE OR ITEM NO. � TYPE OF FIxTURE OR ITEM <br /> IToilet _ PJC-air handling units <br /> i Bathtub _ Forced air systems �' <br /> Lavarory(wa>h basin) _ Gas piping / <br /> _ Shower / _ Water heater � <br /> Kdchen smk 8 CSposal _ Gas fireplace /% <br /> � _ D!shwasher / _ Gas renge <br /> � Ciothes washer _ Clothes dryer <br /> — ry Y � Range hood <br /> _ Laund tra j � Exhaust fan /� <br /> I __ Slnk(servicelbar/mop/et/� — <br /> Backflow preventer j _ Heat pump <br /> Urinal � _ Unit heater <br /> � — � Boiler % <br /> __ Dnnking Fountairf Refrige�tion <br /> _ Floordrain� — WooQsrove <br /> _ Greaseyep — �ef <br /> RooF dfams — <br /> QUi¢f — <br /> � — <br /> i — CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby centify that I have read and examined this apPlication anC know the same to be true and cortect. All provisions of laws and <br /> udinaces goveming this type of work wtll be complied wdh wnether speafied herein or nol The granting of a pertnii does not presume <br /> �o grve authoriry to wolate or cancel Ihe provision of any other state or local law regulating consWction or the performance of <br /> ;,;nsVuc on.That I am authonzed by the owner of this property to perform the work`or which application is made antl I comply with;he <br /> :iate Co�ractcrs Law '8 27 RC}N ard'�6100 'AC. <br /> i ! / <br /> :� ' � ' � . �L.. �/"'� ,�� / � <br /> oace � <br /> S�gnaNre of OwnerlContrac;ouAuthonzetl Agent . /� <br />