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P�RMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, .VA 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 I PARCEL TAX I.D,# P MIT# <br /> rir l�l�u,� 'YIDCr{<•' !�� CGUCC lCCdO �7zc0 �(,Pv i' - (o <br /> LEGA LOTNO. BLOCK TRACT VC� rr�� «" � �• '�W� <br /> DESC. �IL c�-.�n�-� .. �r,�u� „in�� �nn���c�,( ��z7 - �y�...��z�J <br /> OWNER ADDPE55 CITY/ZIP PHONE <br /> E�4rl�;R1�/'r y D�N •!{cf�(�I�IJ � 5l� V'I K�C- i71D1{�' DR� k�UE(i��(�«%q . � �z� - z�b- 1G Z) <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> �;/Ni:'/� �i�yDL'' f�/�lrG�1N0, �-7i� 75 Z-Z"s3(G' <br /> CONTRACTOR �ADDR§SS CITY2IP PHONE ' <br /> .�;� r e����;f��rc�i���,/ j ,� C'u-�>1',� E��xr:�rr -�'is --��E -�'�9� <br /> CONTR.UCENSE p <br /> �G-( � 1��'h�('!V(DI`1 <br /> USE OF BUILDING -�/ HEAT SOURCE CONTRACT PRICE OF WORK <br /> �����`���j��f` �`�f r`� _Eleclric �Gas_Olher �{l� �`�� <br /> WORKDESCRIPTION ,�I�/I'CD.�-G� ��Xllf f(/J�CIII�N� r /�I��TLr� G/��II1 F{ �� I''�C/1� <br /> �N 1��i5� �foU�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTl1RE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toile� A/C—air handling unils <br /> Balhlub Forced air syslems <br /> ( Lava�ory(wash basin) _ Gas piping <br /> Shower Waler healer <br /> J_ Kilchen sink&disposa� _ Gas(ireplace <br /> 1_ Dishwasher _ Gasrange <br /> Cblhes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(serviceNadmop/etc.) Exhausl fan <br /> 6ackllow preventer Hrat pump <br /> Urinal Unil healer <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> _I Roof drains _ Olher <br /> Olher <br /> CIN OF EVERETT IOCAL SALES TAX CODE IS]105 <br /> I hCroby teri[ify UIBI 1 haVe read and exan•aned Ihis application and know lhe same lo be true and correcL All provisions o(laws and <br /> ordinaces governinc�ihis type of work will be complied wilL•whelher specified herein or noL The granting of a permit does nol presume <br /> lo give authority lo violale or cancol the provision of any other slalo or local law rec�:ilaling conslruclion or the periormance of <br /> construclion.That I am aulhorized by�he owner of this property to perform the work for which application is made and I comply wilh Ihe <br /> Sfale Conlrectors Law 1&27 RCW and 296.200 WAC. <br /> // �i <br /> (�,!�/'P( � .�I'�'!�� ,—i/,� /Cl, <br /> Signatur o(OwnedConU ctor/Aulhorized A�ent / ale f � <br /> l� <br />