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1-ERMIT APPLICATIVN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EV[RETT, WA 98201 �—I U—� <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 6 AM TO 4 PM <br /> SITE ADDRESS Q�Z�i PARCEL TAX I.D.� PERMIT i! <br /> ��� � � �„`�i��:c� ia.�. ��cw,>. G��-t37c73g�vc�7 �o �-c�G �. <br /> LEGAL LOT N0. BLOCK TRACT OR SUBDIVISION N <br /> �ESC. <br /> OWNER ADDRE55 CITYIZIP PHONE <br /> �`i� `� ��a•\i\ -e �LL 3 5 Mn-;�t�l A �.n, r-�on��. �llolly �v2� -SSzi-�43 <br /> TENANT NAME CONTACT FOR PERMIT PHONE Z.S c�� � �j�D <br /> ����:,.(� �c,c�'� ��c � ��rv� ����-Cl 1-e E-MAIL .f�-�l�_a A�-�-`�'y � <br /> C�A AD�HES CITY2IP PMOY <br /> C017TR.LICENSE N Q�+(� cL o <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ���`��� � _ �iectric _Gas_Other _ <br /> WORK DESCRIPTION <br /> � �1[�_ Lvl O ��;�1� 11`�' -� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel _ A/C-air handling units <br /> 6athlub _ Forced air sys�ems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower W�ter heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwashcr Gasrange <br /> Clolhes washer _ Cblhes dryer <br /> Walerhealer Range hood <br />- Sink(service/bar/moplelc.) _ Exhausl fan <br /> BackOow preventer __ Heal pump <br /> Urinal _ Unil healer <br /> Drinking Founlain Boiler <br /> Floor drain Re(rigeration <br /> Grease trap Woodstove <br /> Rool drains Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceritify thal I have read and examined this application and know the same to be true and correct. All provisions of la�vs and <br /> ordinaces goveminc�this lype of work will be romplied wilh whether specified herein or nol The granting of a permd does not presume <br /> lo give authority lo violale or cancel ihe provision of any olher slale or local law regulaling construction or lhe pertormance o( <br /> consWction.That I am authorizeA by Ihe owner o(Ihis property to perform ihe work for which application is made and I comply with the <br /> St le Conlraclo �Law 78.�7 F�CW n 29G.200 WAC. ^ i <br /> ' �11 �'J. ___\ /\ . ` .__' k �l`\ V�J <br /> V ` <br /> SignaWre ol Owner/6a'nlrt�cto .Authorized Agen Date <br /> I ;� � � <br /> ��)„ ��-c_ (1�'-�� � A1 �.� {��� (��2�� Pc�a.:l �-.�� �A.-.�> �%0.7 � 1��-C <br /> L - � - ---- . _ ------ - -— — <br />