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t <br /> . <br /> PERMIT APPLICATION <br /> � CITY OF EVERETT PERMIT SERVICES <br /> I 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 tiM TO 4 PM <br /> SITE ADDRE55 PARCEL TAX I.D.# PERMI <br /> 1� `i S�'e��<,-s D�� � l�lv ���y1. oo �0 13 �o i1�1 �'� �-� <br /> LEGAL LOTNO. OLOCK TRACT <br /> DESC. <br /> OWNER ADORESS CITYlZIP PHONE <br /> �L(o� R t��a 7 y��SS 7-7 73'71I <br /> ^i��t t. i7�,h�o D o� ,��" I l��'i N1J S-e-�.,ma..R�� `�asa vi«l. <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> � /� �/ <br /> i <br /> CONTRACTOR F'�'s ADDRESS CITYIZIP PHONE <br /> ���'�'S S� �:,� �4�,.,, /�1in r�c qr� 7� ' <br /> CONTR.LICE�F�pS.�-EA � �"`�39 Rk .�L[) ^ �� 73Jb <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE UF WORK � <br /> R�+��, f -- - °° �. <br /> Eiec:ric �Gas Other� a� ��� � <br /> i <br /> WORK DESCRIPTION � � �'� ����� `� ` �` !� J/�q� I <br /> �nsl, l l ��.� •�, �, � 7 <br /> I <br /> t ��. () � �..w s-� f�.,,, I <br /> — PLUMBING MECHP,NICAL '� <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FI%TURE OR ITEM '� <br /> � Toiiet _ A�'C—air handlin�units I <br /> Bathtub _ Forced air systems � <br /> Lavatory(�vash basin) _ Gas pipin9 <br /> Shower _ Water heater <br /> �I Kitchen sink F disposal _ Gas freplace <br /> i _ Jishwasher _ Gas range <br /> Clothes washer _ Cbthes dryer <br /> �� Laundry tray I Ranae hood <br /> Sink(servicelbarlmopletc.) � Exhaust fan <br /> Backflowprevanter _ Neatpump <br /> I Urinal _ Unil hea'?r I <br /> '� _ Drinking fountain _ Bo!!er • 4 <br /> ', Floor drain _ Refngeralion <br /> i = Grease lrap = Woodstove <br /> Roof drains Other <br /> I _ Other = �� �• y I <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J705 <br /> I I hereby centify that I have read and examineC lhis appl!cation and know lhe same to be true and corect. All provisions o(laws and <br /> �Iortlinaces goveming this type of work will be ccmplled with whether specifed herein or not The granting of a permit dces not presume I <br /> to give authority to vioiate or cancel the provision oF any other state or local law regulating construction or the performance of <br /> constructior. Tha;1 arr.authorized by the owner of th�,s property lo peAorm the�.vork for which appiiwtion is made 2nd I comply with the <br /> State Contrac,crs Law 18.27 RCNJ and 296.200 WAC. <br /> I �f� �?���i.�.�a�/ ( �J-�' O D <br /> �, S�gnature of OwnerlCon actcrlAuthonz ngent Da,e �/ <br /> Z <br />