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( <br /> 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 B AM TO 4 PM g.—�-D—�7 <br /> SITE ADDRESS PARCEL TAX I.D.p PERMR N� <br /> � uc%c� r OLl 7 3�- 5 0/�l vC� X 7��-0�� <br /> LEGA LOTNO. BLOCK TAACTORSUBDIVISIONk <br /> �ESC. <br /> OWNER ADDHESS CITY2IP�&�I PHONE <br /> �nl�n f-ux dy�u9 ��«�rf1.� F,ie:e�+ y�s-s3o-o,a <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> �,C���' Ea.lAll <br /> f�`�� (l'1�1�1CtnCa� � 25AE-- <br /> CONTR.LICENSE/ , ��,(���k1i u� Z�� J�7�OG� <br /> c r�2lsn�t� �isiol R1�ob'�— r�->=� <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PR�CE OF WORK <br /> ��r � <br /> �� /I Electric �'_Gas Other S'(�(,1L — ��'���U -� <br /> ��� <br /> WORK DESCRIPTION <br /> rP�IQ(f. C�� S �iV�cl. 1J0� �P: <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF Fl%TURE OR ITEM NO. TYPE OF FIXNPE OR ITEM <br /> Toilet _ A/C—airhandlinguni(s <br /> _ 6athtub Forcedairsystems ,',;;o <br /> Lavatory(wash basin) � Gas piping <br /> Shower Waler heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washcr Clothes dryer <br /> Water heater Aanfle h�od <br /> Sink(service/baVmop�elc.) Gxhausl lan <br /> � �_ Oack9owprevenler _ Heatpump <br /> _ Urinal Unilhoater .��vu <br /> Drinking Founlain _'_ Boiler <br /> Floor drain Relrigc2lion <br /> Greasc trap _ Woodstove <br /> _ Rooi drains , _ Other <br /> _ Othcr 1�, - — <br /> I <br /> CITV OF EVER[TT LOCAL SALES TAX CODE IS 3i05 <br /> I hereby ceritity Ihat I have read and ezamined this application and know Ihe same to be ime and correcl All provisions of laws and <br /> ordinaces govnming ihis type ol work will be complied with whether specified herein or nol.The granting ol a oermit does not presume <br /> to give authorily to violate or can�el Ihe provision ol any oiher slate or local law regul�ling tunstmction or the pertormance o( <br /> construction.That I am authorized by�he owner ot ihis property to pedorm Ihe work lor which application is made and I comply with Ihe <br /> Staie Contractors Law 1827 FCW and 296.200 W AC. <br /> � .- �. � n^ i (i ��' �–�1'–C'�f <br /> 9igna ure I cTv er/ ontractovAuthorized AgeN ate <br /> � <br />