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PtRMIT APPLICATIt�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM C' �� � �Q� <br /> SITE ADDRESS PARCEL TAl(I.D.# PER T#� <br /> ��ll� VUK;��av(Lr ,�'�lF vo'-13'dS Z9Lo2l,no � � 3-(0 <br /> LEGAL LOT NO. BLOCK TRACi OR SUBDIVISION Jt ,(� <br /> DESC. f(�yK,.Zl. /1U. Z ��, G�12.. �a/£k�E.T1� I�I✓r Y` <br /> OWNER ADDRESS CITYIZIP PHONE <br /> �C� �.tuN i��i� �vc'r✓ho/� f�/, ����i �125 Z59 Z�zl. <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> � �/�it! �{L- �on��78F_ - ;JJNN �ZS 2 3t �H3z- <br /> Ql�b�LSOI�+a E-MAIL <br /> ���A DC-Uf.�o{�A':�`�T. U O 8 J'., � <br /> a c�.,,,ti• , ��c P. rz3u, f_� ry�L�r KtS z3t r�r�� <br /> CONTR.I.ICENSEif �p��� ��C9bL`G <br /> (` <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _/t'1�- _Electric k Gas_Olher � � <br /> WORK DESCRIPTION <br /> �p»�T�o--� ef= Z_ �oRM��Zy IZ� Sf To�� <br /> / <br /> � - f�}1/'rlL.,o�ti r 1 - C��}e.� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FUCTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> l Toilcl A/C-air handling units <br /> Ba�hlub Forced air systems <br /> _j_ Lavalory(wash basin) Gas piping <br /> _� Showcr Waler heater <br /> Kilchen sink 8 disposal Gas fireplace <br /> Dishwashcr Gasrange <br /> Clothes washer Clothes dryer <br /> Waler healer Ranc�e hood <br /> Sink(service/barhnop/etc.) _L Exhausl fan <br /> Dackllow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeralion <br /> Grease trap Woodstove <br /> Rool drains Othcr <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS J105 <br /> I hmeby ceritify thal I have read and examined Ihis application and know Ihe same lo be lrue and correcL Ail provisions of laws and <br /> ordinaces qoverning Ihis type of work��-ill be complied with whelher specified herein or noL The granling of a permit does not presume <br /> to gi��e authorily to violate or cancel the provision ol any olher slate or local law regul2ting consWclion or Ihe performance ol <br /> conslruclion.That I am authorized by the owner ol lhis properly lo peAorm the work lor which application is made and I comply wilh Ihe <br /> Sta�e Con ors Law 18.27 RCW and 2�J6200 WAC. <br /> ���t���--' �'-�� -il� <br /> Signature ol Oi �dContr: .lnt/Aulhorized Agent Date (/ <br /> �--�—�-----�------- — z � <br />