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P`RMIT APPLICATIGrI <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 ADORESS <br />Zti 1 �< <�/ ✓ <br />LEGAL LOTr) . �LOCK <br />DE3C. <br />OWNER <br />��rLh-� �`1 a� /�a:y� 1' <br />TENANT NAME [T <br />PARCEL TAX I.D. # <br />TRAC i OR SUBDIVISION p <br />lZ`l�l V��y,���if?✓0 <br />I CONTACT FOR P IT <br />U <br />CITYIZI� PHONE <br />PHONE <br /># <br />� <br />cL I �Z�G)NS <br />���� R E•MAIL <br />rt� l h b Vti �� Z � <br />� Pv �� �5ciay �".c. fjur Z13 GSY"-c'�e1:) �lNl 9b^�'s6 �7LS 77l-6 <br />CONTR. LICENSE N i `�`�// <br />l��v� �'� P.� oy y Q� __ '�'a <br />USE OF BUILDING <br />t . ,. <br />WORK DESCRIPTION <br />y <br />%� ,vii o c .Q r,U `�- . � �^ j � <br />—� �� PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEM <br />Toilel <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kllchen slnk 8 disposal . <br />Dishwasher <br />Clothes washer <br />Waler heater <br />Sink (servicelbadmop/etc.) <br />Dackflow preventer <br />Urinal <br />Drinking Founlain <br />Floor diain <br />Grease Irap <br />Rocf drains <br />Olher <br />HEATSOURCE <br />_ Elec�ric _ Gas _ Other <br />v� c�F <br />CONTRACT PRICE OF WORK <br />ZO. � <br />N0. ! TYPE OF FIXTURE OR ITEM <br />NC — air handling unils <br />Forced air syslems <br />Gas p:ping <br />Water heater <br />Gas fireplace <br />Gas range <br />C:�-hes dryer <br />Range hood <br />Exhaust lan <br />Heal pump <br />Unit heater <br />�oiler <br />Refrigeralion <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br />I hereby ceiiify ihal I have read and examined Qiis applica�ion and know Ihe same lo be true and wrrect. All provisions ol laws and <br />ordinances goveming ihis type of work will be comphed wilh whether specifed herein or noL The granting of a permit does nul presume <br />lo give aulhority lo viola�e or cancel ihe provision ol any olher state or local law regulaling conslruc�ion or the perlormance o1 <br />construction. T�at I mn aulhonzed by tl e owner ol ihis property to periorm Ihe work for which application is made and I comply with ihe <br />SIaIe Conlraqtors4aw 1827 Ry�N an 296200 WAC. <br />/ <br />/�;�k ��` r�,. , � �-/I -/O <br />I � <br />'-- — — ------- - - — --- <br />7 <br />