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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 8 AM TO 4 PM U —a-a —C�, <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT iF <br /> 3 D L S�L/N� .(�n- _ �'r <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> NER ADDRESS CITYIZIP PMONE <br /> "�., �/�- ,Cl�l�, ,�o z sky�i.✓� r�� Evc�.r� 5(�'�.� L�'ZS,z.��-2�, _, <br /> C R W1Yf (�i <br /> TEN TNAME CONTACTFORPERMIT PHONE � <br /> �/i✓��✓� �['�p�l �,Gif/�t l�_ E�MAIL __ -- <br /> RE I / <br /> CONTR.LICENSE p <br /> USE OF BUILD�NG HEAT SOURCE I CONTRACT PRICE OF WORK <br /> � C- 2 _Elecinc _Gas_Other <br /> WORK DESCRIPTION � Z X ZL Sy ��� <br /> �� �s�i� />e y�,,h l/ �z��r�s/( /Z�c- /�o���°��.,�t- <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> Bathtub Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Shower Waler healer <br /> Kitchen sink 8 disposal Gas firepiace <br /> Dishwasher Gas range <br /> Clolhes washer Cbthes dryer <br /> Waler hi�ater Range hood <br /> Sink(sarvicelbarlmop/etc.) Exhausl fan <br /> Backflow preventer Heat pump <br /> Urinal Unit healer <br /> Drinking Founlain Boiler <br /> f loor drain Refrigeration <br /> Grease Irap Woodstove <br /> Root drains Other <br /> Olher <br /> CIN OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> I hereby ceritify Ihat 1 have read and examined Ihis application and know the same to be true and wrrecL All provisions of laws and <br /> ordinaces go��eming lhis lypr.of work will be complii•d with whether specitied herein or noL The granling of a permit does nol presume <br /> to give authority to violale or cancel!he provision of any olher state or local law regulaling construclion or lhe peAormance of <br /> construclion. That I am aulhorized by the owner of ihis property to perlorm lhe work tor which applicalion is made and I comply wilh lhe <br /> State Conl2ctors Law 18.27 RCW an 296.200 WAC. <br /> �`'I:�=22, ��:ti LZ---- �' z� 'D� <br /> SignaWr ol Owner/ConlraclodAuthorized A�enl Date <br />