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-�` <br /> PERMIT APPLICATION <br /> � CITY OF EVERETT PERMIT SERVlCES <br /> 3200 CEL�AR STREET, EVERETT, WA 98201 I <br /> I 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> i SITE ADDRESS PARCEL TAX 1.0.# PERMIT# � <br /> � % %. �- � i� , �1f°rC�r�_J �� ou,��;��.2;�-co �,�ou > >� � <br /> ILEG4L lOTNO. BLOCK TRACT <br /> DESC. <br /> �' UWNER ADDRESS CITY2IP PHONE t_/�S��j� _ <br /> ' ��►�l.,c�-�� = �"��r `��o� �,�lW� n���i�s�-�,�C�rcle:C����f ������> ox�� <br /> TENANT NAME CONTACT FOR PERMIT _ ��(t��ILL, PHONE <br /> �,��� ��fti����i ��P���'("��5 ?,G�o-'-{��'/71 � <br /> CONTRACTOR � � �!: � �` ADDRESS CITYIZIP PHONE <br /> ; I �ti u���� Se�i ,�t�� <f<� � �i��t�ti�. �1��: r�c��i��.� ;���� ,y��) - <br /> '� CONTR.LICENSE#����LNW������ n ��" I I I �_', _�_� �l �.�,�7� I / I ��� <br /> /v JU�., �� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> .� ,� �� - <br /> � �' f-� _Electric �Gas_Other � <br /> WORK DESCRIPTION <br /> � <br /> �"; ,� r���l<<<<�_ ii�����,� l �,-�s��r-t_�'�'_, <br /> ; <br /> PLUMBING MECHANICAL � <br /> � NO. � TYPE OF FI%TURE OR 17EM NO. TYPE OF FI%TURE OR ITEM <br /> i <br /> I Toilel A/C—air handling units <br /> I Bathtub Forced air systems <br /> I _ Lavalory(wash basin) � Gas pipiny <br /> Shower Waler heater <br /> ' Kitchen sink 8 disposal _(_ Gas fireplace <br /> � Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> ��i Laundry tray _ Range hood <br /> Sink(servicelbadmop/etc.) Ezhaust fan <br /> Backflow prevenler _ Heat pump <br /> �, Urinal _ Unit heater <br /> ' Drinkmg Fountain _ Boiler <br /> ��, � Floor drain Relrigeration <br /> I Grease Irap _ Woodstove <br /> �'� Rool drains Other_ __ <br /> !I _ Other------ — --- <br /> — ---- — --I -- <br /> CITV OF EVERETT LOCAL SALES TAl(CODE IS 3105 <br /> I hereby ceritify that I have read and examined this applicalion and know the same to be true and wrrecL All provisions of laws and <br /> ordinaces goverro�g this lype ol work will be complied wilh whelher specilied herein or noL The granling of a permit does nol presume <br /> � 10 give authouty to violate or cancel thc provision of any other state or local law regulatiny construction or Ihe pertormance o1 <br /> � construction.That I am aathorized 6y the owner of this p�operty ro perform the work for which application is made and I comply with the <br /> � State C�Nradors Law 18 7 RCW and 296.200 WAC. � � <br /> i� �_� � r�.�Ci � <br /> � �:L Cti <br /> Signat re of Owner/ConGacludAuthorized Agent Dat� <br />