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— —� <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEUAR STREET, EVERETf, 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.k PERMIT# <br /> 19�� � .� ��� e �� - � <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> OESC. <br /> OWNER ADDRESS +1 ��s� �3O� PHONF. <br /> � �ehs .�a��,�.sar� 3�(DO l8� " ,� vnnc,lnac�t4�A yz5-774-Sb o <br /> TENANT NAME CONTACT FOR PERMIT —�PHONE �Q�� • 7(r 4• O J 2 J <br /> ' I hf1 �]C 0� r E-MAIL fAnC) �5�o Q;}�j� I . <br /> � � `� J/`C O c�Cn r L (/.� �-•C�S � .� v �°h <br /> CUNTR.LICENSE k � �`/��f f � �� <br /> ,EEsToz' qa i Pc, /0-3 -i a <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �x �Eledric _Gas_Other �S �`(� <br /> WORK DESCR PTION <br /> f, _�l hIJrNOG� ' I �1��� ��a..� � (.�P�.,Pi7 G�^'<'� <br /> ,Y'-- r � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> ,_ Toilet _ NC–airhandlingunits <br /> J_ Balh�ub _ Forced air systems <br /> � Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> � Kilchen sink 8 disposa� _ Gas fireplace <br /> J_ Dishwasher _ Gas range <br /> � Clothes washer Clothes dryer <br /> � Water healer � Range hood <br /> Sink (service/badmop/elc.) � Exhaust fan <br /> Backflow prevenler _ Heal pump <br /> Urinal Unit heater <br /> Drinking Pounta�n Boiler <br /> Floor drain _{_ Refrigera�ion <br /> Grease irap Woodstove <br /> Roof drains Olher <br /> Olher <br /> CITY nF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby certify that I have read anr'examined ihis appfcation and know the same to be true and correcl All provisions of laws and <br /> ordinances goveming�his lype of work will be complied with whether specified herein or noL The granting of a permit does not presume <br /> to give authonly to violate or cancel the provision of any other slate or local law regulating constructlon or the perfortnance of <br /> construction.That I am autho�ized by lhe owner of this property to periorm the work forwhich application is made and I compiy with the <br /> State Conlra rs v,1 W and 296.200 WAC. <br /> � � � � -��P �! O <br /> =�" ` `- i <br /> Signature o�' nedConiractor Authonzed Agent Dale / <br /> rZ <br />