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PtRMIT APPLICATI(,,N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 I <br /> 425-257-8810-FAX 425-257-8857 -www,everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> - � 3-D <br /> SITE ADDRESS � PARCEL TAX I.D.ff <br /> r � � L r„/--�?2; P RMITN <br /> (.� <br /> LEGA� L0T N0. �D-� ' ��J <br /> BLOCK TRACT OR SUBDIVISION q <br /> DESC, <br /> OWNER A�DRESS <br /> ��"! � CITY/ZIP PHONE <br /> ,� ��"�r;�� L���-,, ., /l�Z „ <br /> r J�-���:n <br /> TENAN7 NAME I CONTACi FOR PERMIT <br /> PHONE <br /> � G� �� ��(i Sl ,�e'7-i >"C-'> <br /> ONT A T R l.�c�' �� E-MAIL �'<s�t :F::�r / <br /> /"�J��/' i�I�� �/•, ADDR SS IN/ZIP �_. n �,i <br /> / (� .,. <br /> CONTR.LICENSE# J S �c�i ���~ ��� `C.} ��,. . �� �, � q <br /> C �(1> ) �"c7� <br /> USE OF BUILDING I — — � } L7 <br /> HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Eleclric _Gas Other <br /> WORK DESCRIPTION <br /> _�=i�. >��,�(� �t �� ���-� . �,�,� �� i�<<�� s �'-,�� <br /> / ; <br /> ��l' ��i�i r-. ��� ri(�vt� :�G7�"Z G�2.i't � G^�,� �C�-.., /- �'•%« r' <br /> . �.. f _ t-` � <br /> PLUMBING MECHANICAL <br /> N�• TYPE OF FI%TURE OR ITEM N� <br /> TYPE OF FIXTURE OR ITEM <br /> Toilet <br /> Balhiub A/C-air handling units <br /> _ Lavatory(wash basin) _ Forced air syslems <br /> Show�r Gas piping <br /> _ Kil<:hen sink&disposal _ W�'�en c�ater <br /> Dishwasher _ Gas fireplace <br /> Clothes washcr _ Gas range <br /> ,,,���/// Water healer Clolhes dryer <br /> ,.���- Sink(serviceNarlmop/etc.) = Range iiood <br /> �'� Urina'I��v nreventer — Er.ha'U�an <br /> Heat � p <br /> Drinking Fouiilain _ Unit heater <br /> Floor drain _ Boiler <br /> _ Grease Irap _ Refrigeralion <br /> Roof drains _ Woodslove <br /> Olher Olher <br /> CITY OF EVERETT LOCAI.SALES TAX CODE IS J105 I <br /> I hereby ceritify Ihat I have read and examined ihis applicalion and knew the same(o be true and correct. A!I provisions of Izws and I <br /> ordinaces governing Uiis lype ol work will bc complied wilh whelher specified herein or nol.The granting of a permil does nol presume <br /> lo give authority(o violate or cancel fhe provision of any othr.r state or local la�v regulatinc�censtruclion or Iho peAormance of <br /> Iconstruclion. That I am aulhorized by the o�.vner of Ihis property to pr.rform lhe work for which applicalion is made and I comply with ihe <br /> Sla�e Cnntraclors Law 18.27 RCK�and 29G.200 WAC. I <br /> i - .� -z_... _� ._---"-.'� ( � <br /> Si nature nf n�y � 3� Z� I � <br /> 9 ncrtiuntraclor/Aut iolved Aqenl Dale <br /> �----- - --------- --------- — I <br />