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PERMIT APPLICATION <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 ADDRESS PARCEL TAX I.D.# PERMIT# <br /> � % << ��� ��, F r�' �fes1� G� I,'L �';C�'i(7S-0Z1 <br /> LEGAL l LOT NO. BLOCK TRACT OR SUBDIVISION <br /> oesc. � SL[� �I �GcJ �� �3GC� -lad,b' -,3/ " 7 <br /> OWNER ADDRE55 CIN21P PHONE <br /> C �1fI J `Y � UII'v �l'. �i�� � � ''� �� ��� l�� lf� L�CS � Ill� �'- �l�i�C'II� G�� ���C� � <br /> TENANT NAME CONTACT FOl;PERMIT � ��N� O G L- <br /> � � �� �1 a� ,�7�,�.,,, c�,,s7� . C ,cil `Y �iFrNci � i1C .�c%G • yl9' <br /> (�h i � Z •i� J u n c�. _7 <br /> f�tv���a � S L�� rl�er E•MAIL Lc�)Cti�JJ��t(n�, C' "n.l <br /> C NT ACT R ORESS � � <br /> /�,�rthE ,-�) Cc,tist�u< �, ��,` ,�c�l,, , y�� . �cs.z <br /> i ��P��1CC/F�� SN�, yy/i[� /77f/�rL/iQ/�'AU � N <br /> CONTR.LICENSE p r, <br /> ti���ill� i� a�2 �1�-�� T, �� i;p , �� A 9k� �i <br /> USE OF 6UILDING HEAT SOURCE Fi� ��:rI c�r CON7RACT PRICE OF WORK <br /> ���",� �- ('��..� �c � _Eleatric x Gas_Othor ,.� C� � C C C� — <br /> WORK DESCRIPTION ����� � C, i,� �C f ��n'� � U �� i [ L '� ��1�+' �j`�4 � <br /> PLUMBING MECHANICAL <br /> NO. TYPE Of FIXTURE OR ITEM NO. TYPF OF FIXTURE OR ITEM <br /> Toilot NC-air handling units <br /> Bdihlub Forced air syslems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Waler healcr <br /> Ki�chen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clolhes dryer <br /> Water heater Range hood <br /> Sink(servicelbar/mopletc.) Exhausl fan I <br /> Backllow prevenler Heat pump <br /> Urinal Unit healer <br /> i = Drinking Pounlain � 6oiler <br /> Floor drain Refrigeration <br /> Grease Irap Woodstove <br /> Rnof drains Other <br /> Other <br /> � CITY OF EVERETT LOCAL SALES TAY,CODE IS 310ti <br /> I hereby cerili`y lhal 1 have read and examined this application anA know the same to be irue and cortect. ��I provisions ol laws and <br /> ordinaces goveminy Ihis lype of work will be complied wilh whelher speci(ied herein or not.The granlinc�of a permil does nol presume <br /> to give aulhorily to violale or cancel the provision of any olher state or local law reyulating consWction or the perlormance oi <br /> conslruction.Thal I am aulhorized by lhe owner o(lhis property to perform the work br which application is made�nd I comply wilh the <br /> Slate Conlrectors Law 1827.�2CW.and 296.200 WAC. - i <br /> �-�..�� .���� ��ti � -.'�j`��� l <br /> SignaWre of OwnedConlraclodAuthonzed Agent , ale 7 <br /> / � � � �'7 /l�l, Ttl �;_, �' � �1� �� <br /> 1 i I)P ( il '` �- <br /> . . � i� — _ .. ._ _.--- � <br />