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� cRMIT APPLICATl.�N <br /> CITY C� EVERETT PERMIT SERVICES <br /> .'200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> . APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT N <br /> c , �e ,�� � �� C�S f � a �a �I �� ( c:c�-cba <br /> LEGA LO/T�NO1. /-B� LOCK(� TRyA�CT�OR SUBDIVISION�I <br /> DESC. -I '"D C-� r(3. �'J' �� I l� : C � <br /> OWNER n ADDRESS CITYIZIP PHONE <br /> �ac�� �� 1'�� FL;�'� � �O ��x �SS l E'Ye.!ef/ �gaa6 �,7S�C�, � <br /> TENANTNAME — I CONTACTFORPERMIT PHONE � — ' <br /> E�MIAIL �aLO� �,�JOI0.YtQ � <br /> _Zr6FTFCiS �8 <br /> 0���_�' 1i <br /> CONTR.LICENSE N �— <br /> USE OF BUILDING � HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��.j �(1/�(j 7/�,I / , __Eleciric �Gas_Other — II <br /> WORK DESCRIPTION �,J � <br /> C'o��� � r^UL�' GnuPlF�x be_�, , �,�I � U��P��f- up1�� I <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toile� FVC-air handling uni�s I <br /> � Balhtub _ Forced air systems <br /> � Lavalory(wash basin) Gas piping <br /> Shower � Water heater • <br /> �- Ki�chen sink 8 disposal Gas 5replace <br /> � Dishwasher Gas range <br /> ,;� Clolhes washer Clolhes dryer I <br /> � Water heater I�ange hood i <br /> Sink(service/badmoplelc.) . Exhaust tan I <br /> Backflow preventer _ Heat pump <br /> Urinal Unit heater • <br /> Drinking Fountain _ Boiler <br /> Floor drein Reirigeration <br /> Grease irap _ Woodslove <br /> Rool drains O�her <br /> Olher � <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 7105 <br /> I hereby certi(y that I have read and examined this application and know the same to be Irue end corted. All provisions oi laws end <br /> ordinances governing this type oi work will be complied with whether specified herein or not.The granting ot a pe�mit does not presume <br /> to give authonty lo violate or cancel the provision o(any olher state or local law regulating construdion or the performance of <br /> construction.That I am aulhorized by the owner o1 this property to periorm the work lor which applicatio�is mede and I comply with the <br /> State CoM�actors�aw�8.27��$C1N�and 296200 WAC. <br /> �" �%' -��= � �� /6' <br /> Signature�oY v �edCOMraClodA�onzedAg"et�� Date II <br /> Z <br />