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P�RMIT APPLICATI(�N <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.N P MITl1 <br /> i��Z/ ���:r,- yt ,��i/-oo3 <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION p <br /> DESC. <br /> OWNER ADDRE55 CITYIZIP PNONE <br /> C'l�cr i�1CS �/nrlh /�z ( �2��a��- ti�Zg -�li��� Gf?1= ��� <br /> TENANT NAME CONTACT FOR PERMIT PNONE <br /> :��s-26T3 ��7ZZ <br /> �C�� ����I/�'�Z E-MAIL <br /> ONTRAC O � �G , � , '' nC D S T�ST� I� �7 p <br /> CONTR.LICENSE p y'� C�%� V�� '� I��CX�� Z6/� lv.lwSi1HC f� �-{' LI�Z•I-- C L� O <br /> Y-v2�—f'� � ��►T f't�Z�'j �'{ ��Z <br /> USE OF BWILDING �/ /fi,/Gp HEAT.iOURCE I CONTRACT PRICE OP WORK <br /> 7 c� � � <br /> Gc�r«t� _Eleciric __Gas_Other I '+ (9, �C7G�• � ^��i�,v� <br /> 0 <br /> WORKDESCRIPTION ��� � ��,��� �g,¢ S f i.-��`"""`r' '` <br /> , � ' / v� 1 -�_�'�%r: ��L1�11, � � <br /> _�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYFE OF FIXTURE OR ITEM <br /> Toilet A/C–air handling units <br /> Bathtub Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Sho�ver Waler heater <br /> Kilchen sink 8 disposal Gas fireplace <br /> Dishwasl;cr Gas range <br /> Clolhes washer Clolhes dryer <br /> Waler heate: Range hood <br /> Sink(serviceNarimop/etc.) Exhaust(an <br /> Dackllow prevenler Heal purrp <br /> Urinal UNt heatcr <br /> Drinking Fountain Boilcr <br /> Floor drain Refrigeralion <br /> Grease irap Woodstove <br /> Rool drains Olher <br /> Othcr <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby ceritify Ihal I have read and examined this appiication aod know the same to be true and correct. A�I provisions o(laws and <br /> ordinaces goveming lhis lype ot work will be coniplied with whelher specified herein or noL Th�granling of a permit does nol presume <br /> to give aulhority to violale or cancel the provision of any ulher state or local law regulating construction or the performance of I <br /> consUuclion. That I am autholized by Ihe owner of ihis properly lo perform�he work for which application is made and I comply wilh Ihe <br /> Stalc Contraclors Law 1(1:27 RCW and 29fi.200 WAC. <br /> , � \�^ _ _�� ..�._ ( C _ 2 � <br /> Signature o(Owner/ConiraclodAuthorized Ac�enl Date � <br /> II v <br /> ! . ._ _ ___— _- . . —_— — _ <br />