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r <br /> PERMIT APPLICATIt�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 9H2O1 <br /> 425-257-8810— FAX 425-257-8857—www.everettH�a.org <br /> 11PPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SIT ADDRESS � PARCEL TAX I.D.# PERMIT# <br /> � )p� �" (,{� �'��Q.� O L (o c01 OU 0`�' �' �35 <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. 171�n . �QG�-17, <br /> OWNER� � ADDRESS CIN21P PHO�— <br /> <y�-t�7�1�' 1 1° u� {'� I �/�D� S �..� f�-J I n.i ra( r�-1 ��2��.�Qel J'd/��(� <br /> TENANT NAME CONTACT FOR PERM!T PHONE L/ZC-�—(p",C' JS <br /> �-�9C1�Y G� �L�I�' ��� .V l/ ✓Wi �l `V�.1 -�^'� (� E-MAIL lY� �G I��L�t �� <br /> N RA T AD E S I IP PH �,� ''j7�� • <br /> ���-v, t�� �9o�i l�-P-�nu��e �d�-a ; <br /> CONTR.LICENSE p <br /> USE OF BUILDING � I HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��/�� �� ������1 �Eiectric �as_Other ���, <br /> I / <br /> WORK DESCRIPTION � ��• ���{' �l( j L f !'�(' S�U C�� �� ���u"T <br /> �I 2h � <br /> ��� � T s L���1�, y)��� �'- <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilcl A/C-air handling units <br /> BathWb _ Forcedairsyslems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Water healer <br /> Kitchen sink&disposol i_ Gas tireplace <br /> Dishwasher Gas range <br /> Clothes washer _ Cblhes dryer <br /> Waler healer Range hood <br /> Sink(sen�iceNadmop/elc.) _ Exhausl fan <br /> Back(low prevenler __ Heal pump <br /> Urinal _ Unil healer <br /> Drinking Fountain . _ Boiler <br /> Floordrain . Rafrigeralion <br /> Grease Uap Woodstove <br /> Roof drains Other <br /> O�her <br /> CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br /> I I hereby ceritify thal I have read and examined lhis application and know Ihe same to be true and correct. All provisions ot laws and <br /> ordinaces governing lhis type of work will be complied with whether specified herein or noL The granting ot a permit does not presume <br /> to give aufhority to violate or cancel Ihe provision of any other state or local law regulatin9 construction or the performance o1 <br /> const�cC n.Thal I am aulhorized by lhe owner of lhis properiy to pertorm lhe work for which application is made and I comply with lhe <br /> i <br /> Sta C Cont aclors Law 78.27 RC and 296.200 WAC. <br /> � � �� t � �Yti,�U�;i�< /��d��� � � <br /> Sig ture of OwnedContractodAuthonzed Agenl Date <br /> �_--- ---- — --- � <br />