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i <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 n j PARCEI TAl(I.D.N PEHMIT N <br /> ��L'�� jt4 �;�'1�5 I)�S l�(.�� ��1.�( l !�L�C�� �_�:J� <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRESS CITY2�P PHONE <br /> � 3-�z,L <br /> i- 'I,��, (t�nnr�a/ ,zoU--3- <br /> TEN�NT NAME I CONTACT FOR PERMIT PHONE 153 -Y�4� 1 t3� <br /> Ec�l TiJ✓l[�� IJG�'1AI[I �.�u7r��, E�MIAIL ��.�K-.}� li��.w�+�e..�ZL� � I LLH <br /> AN�rEu� ce.�lr� � �'1�� Rs�Nw �9v,h.:�.� �trcc� �2s3-Y�N <t�►33 <br /> CONTR.LICENSEN �a ��—y�[�,�7� �b11' <br /> USE OF BUILDING NEAT SOURCE I CONTRACT PRICE OF WORK <br /> �'C^+�iPi�c�� z� � _Electric _Gas_Other �,;z S.S�. �'�' <br /> ����5• � v , <br /> WORK DESCHIPTlON <br /> ��GUI�"e� 5������,( 'L:tc:� fC � U-�� c.`� �-4.uti, <br /> V <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTUAE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A'C–air handling units <br /> Bxihtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shc•.ver Water heater <br /> Ki�chen sink&dispc;al _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Wa!er heater Range hood <br /> Sink(service�baqmop�etc.) _ Exhausl fan <br /> BackBow preventer _ Heat pump <br /> Urinal Unil healer <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease irap _ Woodstove <br /> __ Rool drains � Other � c�.. ' � <br /> Other _ _ -�1(�.Qt�r y r'L <br /> _ _ �r-ll <br /> t� <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3105 <br /> I hereby ceritily ihal I have read and ezamined Ihis application and know the same to be true and correc�. All provisions of laws and <br /> ordinaces goveming Ihis type of work will be complied with whe�her specilied herein or noL The granting of a permi�dces not presume <br /> lo give aulhoriry to violate or cancel Ihe provision ol any other sta�e or local law regulaling construction or�he pedormance of <br /> construclion.That I am authorized by Ihe owner ol this property to pertorm the work for which application is made and I comply with ihe <br /> SIa_ CoMractors LaiYT831��W and 296.200 WAC. <br /> � n ( I � L//J/t'� <br /> � f�V � <br /> SignaWre OwneriC iraclovAuthorize��Ag�nt� ` Da� <br /> _�.. <br />