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PtRMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES C� ..�-o� <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org i <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 31�'IJ I G� <br /> SITE ADDRESS ��� `� � � j��t��`'� PARCEL TAX I.D.# PERMIT# <br /> �l �� � c 2 I � (Z. �' � -> � V �� � Uf501 - S S <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER AD[1RESS CIN21P PHONE <br /> � ( .,� :� ', � ,� �i� i� Iv ��nrJ �1�� \� i��UC �1E R c` v�CRF � i �cC� 155 }7 � <br /> TENANT NAME CONTACT FOR PERMIT PHONE � <br /> , � t <br /> � ��;c, 3 ; z ,�, � 5 <br /> C �P, � S�� 1\ 1 :�?� ��iti � `'-lv 1V� � E-MAIL <br /> CaNTRACT R DDRES � � � 1��� f .� � L 1 � <br /> d <br /> y C�� `s"� 1�__ �\t>z ia �� U hl�� i '�,i � :� � 1v c L� , <br /> CONTR.LICENSE N t��,\ I'a ' � `�'�� �, U � 4 �1U � � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Eleclric Gas Other <br /> WORK DESCRIPTION <br /> ��(. 'ti uc? ` i� �1-- <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling units <br /> Balhtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shrnver Waler healer <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwashcr Gas range <br /> Clothes washer Clolhes dryer <br /> Watcn c�aler Rangc hood <br /> Sink(servicelUadmop/etc.) _ Exhaust fan <br /> Backflow prevenlcr _ Heal pump <br /> Urinal Unit heater <br /> Drinking Founlain _ Boiler <br /> Floor drain Refngeralion <br /> Greasc Uap _ Woodstove <br /> Roof drains Other _ <br /> Olher <br /> CITY OF EVERETT IOCAL SALES TAX CO�E IS J105 <br /> I hereby ceriti(y ihat I have read and examined this application and know ihe same to be lrue and c�rrecL All provisions ot laws and <br /> ordinaces�oveming Ihi,lype o(work will be complied wilh whether speci6ed herein or noL The granting of a permil does nol presume <br /> lo give au0iorily to violale or cancel the provision oGany other sl2te or 1oc21 law regulaling constniction or lhe perlormance ol <br /> cons�ruclion.ThaU am aulhDrized by the owner�this property lo perform Ihe work br which application is made and I comply with the <br /> State Contracln�s L,m4'18.2`7 RCW and '296.20 1M1'AC. <br /> ;; , Oy�jz� C% <br /> Si9naWrer.�Of� n IContfac � ed Ac�ent Dale <br /> V <br />