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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425457-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMI�T-A � <br /> � .S �� r,� /�, � �� � <br /> LEGAL LOT NO. BLO�K TRACT OR SUBOIVISION p <br /> DESC. <br /> OWNER ADDRE55 GITY/ZIP PHONE <br /> /�/G� S?• /wvESTiJs�rv3 <br /> TENANT NAME C NTACT FOR PEfiM1T PMONE <br /> ��5,�1,� 3ii� <br /> /�JYc2L /J?9/[i�_ ��(.7.� - �G�L 11/t.Cf�'''L- _�Maa <br /> �A� $S � 1TF/TIF H N <br /> E7ic:�2Gitwrr�r 5:� N�'J' - •P/c l�Z� ����f'�G ,qc6 &v. �d�"� c <br /> CONTR.LICENSE p Z� Z � �I/ � <br /> 6l.�Ytl f5 O l' O <br /> USE OF BUILDIkG I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> /1yh.yGa�¢-LjZc2�v(� _Eiectric ,xGas___othcr g�✓r bU <br /> WORK DESCRIPTION <br /> //i/S%7�LG Ai4�t�'�L�G"� �ev�'TI7/� Gf/L�i ` O<ici <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet AiC-air handling units <br /> Balhtub x Forced air systems <br /> Lavatory(wash basin) _f Gas piping <br /> Shower _ Water heater <br /> Kitchen s�nk& d�sposal _. Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer ___ Cloihes dryer <br /> Water healer Range hood <br /> Sink(servicerbacmop'etc.) _Z Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal _ Unit heatcr <br /> _ Drinking FouNain ____ Boilor <br /> Floordrain __ Refriqeration <br /> Grease trap _ Woodstove <br /> Rool drains _ Other __ <br /> -�-- Other — — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examinetl Ihis applicalion and know the same to be true and correcL All provisions ol laws and <br /> ordinaces yoveming this type of work will be complied with whelher specified herein or nol.The graming of a permit does not presume <br /> to give authoriry to viola�e or cancel the provision of any other state or local law regulatina consWction or the pertormance of <br /> construction.Tl�ettvm authorized by the owner ol this property to perlorm the work lor which application is made and 1 comply with ihe <br /> Statc Co/�ac�tors w 1827 R`CW�a�nd 296200 WAC. <br /> d�- /� %�ic--- 7- Z d�o S� <br /> Signa�urc ol Owner/Contracto Authonzed Agent Date <br /> � <br /> � z <br />