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f�cR11i�IT APPLICATIuN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810–FAX 425-257-8857–www.everettwa.orc� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � `a. �—�D <br /> SI E ADD •SS ' PARCEL TAX I.D.# 2�5��f� PERMIT p <br /> `''x �h-" �� ��-'��,��o s ��lJ-L'O ��� />�1'/'��JiTI <br /> LEGA LOT NO. BLOCK TRACT OR SU IV�ISION p <br /> DESC. <br /> OWNER A�DRESS CITYIZIP P ONE -- �3 7� <br /> � <br /> � C _ G(L . , � . ` . <br /> T NANT NAME ,� CON FO HONE �3 �j? �S� <br /> � I�/�1�1� l'�Co$��"�r' P�/,�Jn.�L� _ 1 <br /> � '%A-� c /i�(I - -- —� E-MAIL OZZ L <br /> L���/\ , ' I , (�� <br /> CONTR.LICENSE 0 �I��L(' �� I / �� ' /, l-Tt �:TO J <br /> �)ns-�G���fi0� �� /(i'�/J��' � c/Yh CF.hI2f Lv�' �� 7 �/y.�Ll+t a'.L <br /> USE OF BUILDING HEAT SOURCE CON RACT PRICE OF WOR <br /> ���?%�/n �y.�� I �Electric VGas_O�her � �� ��" <br /> r�l��! �-^��, <br /> WORK DESCRIPTT��AN� /��/�/2J//����{i�r' T �j/.�'(a{� ( 'rJCU%'� �� <br /> �i� .�-�'%r-�.� Lh�',+�n1 j r��-i�L��c� � f� ��/��x� . <br /> l' _� �� > <br /> LUMBING MECHANICAL <br /> NO. NPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet � NC-air tiandling untls <br /> Balhtub ^ Forced air systems <br /> Lavatory (wash basin) � Gas piping <br /> Shower Watcr healer <br /> � hitchen sink&disposal Gas(ireplace <br /> Dishwasher T Gas range <br /> Clothes washer Clolhes dryer <br /> / Water healer -� Range hood . <br /> l.� Sink(seivice/badmop/e�c.) � Ezhaust fan <br /> � �ack0ow preventer Heal pump�, <br /> Uiinal - Unil healar `\ <br /> Drinking f=ountain Boiler <br /> � Floor drain ��, _ Refrigeration <br /> �_ Grease Irap �'�. Woodslove <br /> Roofdrains = Other ILf�+�IU- �L � <br /> � Other�� _ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify lha� I have read and examined Ihis application and knmv�he same�o be irue and correct. All provisions of lawe and <br /> ordinances governinc�Ihis type of work will be complied wi�h whe�her specifed herein or not. The granting of a permit does not presume <br /> to give auUiority to violate or cancel the provision of any other stale or local law regulating consiruction or the performance of <br /> construction.That I am autho�ized by the owner of Ihi roperty ro pertonn ihe work for which application is made and I comply with the <br /> State CoNraclors Law 8.2 i RCW and 29�2001M1'A .' /� <br /> �1 � / r7 l. <br /> � : / , � �'il�I�� � ( !— � '� <br /> SignaWre ofpWner C�clodAuthorized AgehV Date � <br /> ----- -------- - ----- V------ -- ---- -- - �J <br />