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! <br /> PERMIT APPL,ICATION <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 /p .�(j-O � <br /> SITE ADDRESS PARCEL TAX I.D.� P M� <br /> .�'f�' � S H c(cL ,. I� � IO -U/ / <br /> LEGAL LOT N0. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRESS CIN21P PMONE <br /> ' -'v�� : N�nE � �,.Mt �IzS - 3s�j-�vu3 <br /> Ja„ �. W r�� <br /> TENANT NAME CONTACT'OR PERMIT , PHONE 3 S� � �/y 3 <br /> . �.��uY�. � U��1�`4��'�. �ia�� � � . l��� E�IAIL <br /> 1� I �_��.�.�l.kee� _— <br /> L A §$—� G I <br /> ', rl 9��1 yzl-Zs'�i�vGiv <br /> �l�\,1�(1��,J ��/r��cc c.—c 1 � � � .�v J �cC �hi�J �ciP/�r� <br /> CONTR.LICENSE p <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> j��'�, _Electric _Gas_Olher <br /> WORK DESCRIPTION <br /> � � �/ /� ��T <br /> �� ,.��, 1�..-_� <br /> PLUMBING MECHANICAL <br /> NO. � TYPE OF FIXTURE OR ITEM NO. TVPE OF FIXTURE OR ITEM <br /> Toilcl _ aC–air handling unils <br /> 6alhtub __ Forced air systems <br /> Lavatory (wash basin) Gas piping <br /> Shower I Waler healer <br /> Kitchen sink 8 disposal ��f Gas tireplace <br /> Dishwa��,hcr _ Gas range <br /> Clothes v�ashc�r _ Clolhes dryer <br /> Waler heater _ Range hood <br /> Sink(se rvice/bar/moplelc.) _ Exhausl fan <br /> Backflo�v prevenler _ Hea�pump <br /> Urinal _ Unil heater <br /> Drinkino Founiain _ Boiler <br /> Flo�rdrein _ Refrigeration <br /> Grease Irap _ Woodstove <br /> Root drnins _ Other <br /> Olher — � • <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify thal I have read and examined lhis application and know Ihe same lo be lrue and correcL All provisions of laws and <br /> ordinaces goveming this type o(work will be complied wilh whcther specilied herein or not.The granling uf a permit does not presume <br /> lo give aulhorily lo violate or cancel the provision of any olher slate or local law regulating construction or the performance of <br /> conslruclion.That�am authorized by lhe owner o(Ihis property lu perform the work(or which appticalion is made and I comply with the <br /> Stale Conlractors Law 1827 RCW and 296.200 WAC. <br /> � i �.� /- '"4'l� <br /> i F.--/ <br /> ,S1 nature of OwnedConUaclor/Authorized�gent Dale <br /> �. <br />