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PERMIT APPLICATIO�I <br /> CITY OF EVERETT PERMII SERVICES <br /> 3200 CEDAR STREET, cVERETT, `NA 98201 <br /> 425-257-8$10 - FAX 425-257-8857 -wtivw.e�erettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO A PM � —(�5�� <br /> SITE ADDRESS PARCEL TAX I.D.# PER;�11T r <br /> � 05' L( OTH ST Cvc���� zqo.�3 0�0 3 0 3900 �o�o <br /> LEGAL LOT N0. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER A�ORESS CIN/ZIP PHONE <br /> pccKy Ev��vs qo,s YoTy sr FvcRci7 �✓A., �l�z�l 'f�,,-z36 - 6o05 <br /> TENANTNAME CONTACTFOR PERMIT PHONE <br /> E-MAIL <br /> CONTRACTOR ADDRESS CITY/ZIP PHON yjs-SrY-St sl <br /> Tk�lY/�t= Y l'�L'(�f1;(2 !}Np f r NTEN�tA(CE ?( oo EVcR6(�EEn wKy P_vc'R��I� 98Zo� <br /> CONTR.LICENSE N ' <br /> iuRNKRNo 661'3 7uRnlKR�7�9SDF /!�/9/�� <br /> USE OF BUILDING HEAT SOURCE CONTRAG?PRICE OF WORK <br /> RC-S> D L hl C E �Eleclric _Gas_Other � ���4 � � <br /> WORK DESCRIPTION <br /> �Riu�r'�GC- cT'2iC/1� BoXEs oc�7' TuA<cN�q�OD,4TE NEw SHcETRo �/�� <br /> TNST,4LC S/fEC-T2oclC aN w�LLS ? �CiLf/rG or- GqRaG� , � 3a'i Sq,F7 <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM I <br /> Toilet A/C-air handlina unils <br /> Bathtub Forced air systems <br /> Lavatop� (wash basin) Gas piping <br /> Shower Water heater <br /> Kilchen sink&disposal Gas fireplace <br /> Dishwasher Gas range i <br /> Clolhes washer Clothes dryer <br /> Water healer Range hood <br /> Sink(service/bar/mopletc.) Exhaust fan <br /> 8ackflow preventer Heat pump <br /> Urinal Unit healer <br /> Drinking Founlain 8oiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roo(drains Other <br /> Olher — <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 I' <br /> I hereby ceriti(y thal I have read and ezamined this application and know the same to be true and wrrect All provisions of la�vs and I <br /> ordinaces goveminc�this type of work will be complied with�vhether specified herain or noL The yranting of a permit does not presume <br /> to give aulh:ority to violate or cancel the provision of any oiher stale or local law regulating construclion or the performance of I <br /> construction.Th am aulhorized by lhe owner of this properly lo periorm the work(or which application is made and I comply with the I <br /> Slate Contra Law 16.27 and 296.200 WAC. <br /> u 1J Gh-�-e6'-� C/ ✓ � �I <br /> S�ure of Owner! niraclor/Authorized Agent Date � <br /> �--v--- I <br /> —� <br /> J <br />