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PtRMIT 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 <br /> SITF.ADDRESS PARCEL TAX I.D.# PERMIT# <br /> .5�3�� �� Y,� � � -0 <br /> LEGAL LO7N0. BLOCK TRACT <br /> DESC. <br /> OWN A�DRESS CIN21P PHONE <br /> - � , ,% z� /1D s'!sY .cz�� l.�� ` � �s`�- <br /> TEN NAME CO TACT FOR�PjERMIT PHONE <br /> '� %IG��YC///K Y F��-��i <br /> COtR ACTOR � AD S / CITy21P PHONE /'�S�� -l/ <br /> /���"/'il�'1 �I/N��` L�'�'/� �.�( rsa-�P A� S� .S+rel+Cr�%5� ��O <br /> CONT�.I.I EJ�S�#` � / <br /> /y��� �1���71N� <br /> USE(;F HUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> / /_ 1�,� . _Elec�ric �as_Olher ��� <br /> ri' /L' <br /> WORK DESC/R/I N n // �/ /� � /�jJ / .✓ ,o�y�� S <br /> ��irCt' �'�"/��f��w' �fJ�'{th�t �4,rC�✓ /%r 2 c-'Th�H(,° �jix�C �f°� lP,C2"�'6G' r7 • <br /> f ! / � <br /> F�'' /1E'�J ��///�s lLbz�`� �' � .�`�c`ff�'l/NL° <br /> PLU BING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITf:A1 N0. TYPE OF FIXTURE OR ITEM <br /> Toilel _ FVC-air handling units <br /> Bathtub _ Forced air syslems <br /> Lavalory(wash basin) _ Gas pipinc� <br /> Shower _ Waler heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gasrange <br /> Clolhes washer _ Clothes dryer <br /> Waler healer _ Range hood <br /> Sinlc(service/badmopfelc.) _ Erhausl(an <br /> Backflo�v proventer __ Heat pump <br /> Urinal Unit healer <br /> Drinking Founlain _ Boiler <br /> Floordrain _ Refrigeration <br /> Grease trap _ Woodstovo <br /> Rool drains _ Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cenlify�hat I have read and examined this application and kno�v Ihe same to be lrue and wrrecl All provisions ot laws and <br /> ordinaces govemin�. -� .��type of work will be cemplied with whether specified herein or noL The granling of a permil does nol presume <br /> lo c�ive auth �ty lo•ro,:ile or cancel Ihe provision ot any other state or local la�v regulating construction or the performance of <br /> construclio i. �hat am y' lhor2ed e owner of this property tc peAonn the work for which application is made and I comply with the <br /> Slale Cont ors La�Y1 .27 RC < d 29f.20D WAC. <br /> ' a-a�r> <br /> Signalure I OwnerlContractodAuthonzed Agent `� Date <br />