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c c <br /> PERMIT APPLICATION ' <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br /> SITE ADDRESS � PAPCEL TAX I.D.R PERMIT M <br /> 2�v� .�.��srwa � o0 37 23b1 M1o((�- 3 <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION� <br /> OESC. � �DD �,y I� I L <br /> OWNER AODRESS CITY2IP PMONE <br /> S�'�rRE�' i u�, N ��zs- w���QAYa ��-m 9$�1 4�'z7;-3ry8 <br /> TENIINT NAME I CONTACT FOR PERMIT PHONE (,�2 5= 2-T 3'3 7 � <br /> NA Je-��Nc�N EdAAIL Jn��;�Cc'.�H.wa. S <br /> CONTR.LICENSE R a�a7 n/eN' <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRiCE OF WORK <br /> `rS1.��1J l _Eleclric /�Gas_Other <br /> n <br /> WORK DESCRIPTION {� .4'�RP��cc !ti 9�+L �Jn-IIn.S ��e• <br /> ln$�t�� T��f11�a� Q1(N- <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FI%NRE Oli ITEM <br /> Toilet _ A/C–air handling unils <br /> Ba�htub Forced air systems <br /> Lavatory(wash basin� � Gas pipinp <br /> Shower Water heater <br /> Kitchen sink&disposal � Gas fireplace <br /> Dishwasher _ Gas range <br /> Clothes washer _ Clothes dryer <br /> Water healer _ Range hood <br /> Sink(serviceNadmopletc.) _ Exhaust fan <br /> Backflowpreventer _ Heatpump <br /> Urinal _ Unit heater <br /> _ Drinking Fountain _. Boiler <br /> Floor drain _ Refriperation <br /> Grease trap _ Hloodslovo <br /> Roof drains _ Other <br /> Other — <br /> CITY OF EVERETT LOC�L SALES TAX CODE IS 7105 <br /> I hereby ceritity that I have read and examined this epplication and know the same to be true end correct. All provisions ot laws end <br /> ordinaces governing this type ol work will be complied with whether specified herein or not.The prantinp ol a permil does noi presume <br /> to give aulhority to violate or cancel the provision of any other state or local law regulating constmction or the performance of <br /> consiruction.Thal I authorized b the owner of this property to perform the work for which application is made and I comply with lhe <br /> Sla�e Cont rs w 18.27 RC n�29620D WAC. <br /> /� �Z /U <br /> Sigi aWre / c�od uthon etl Agen� Date <br /> i <br /> I <br />