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P�RMIT APPLICATION I <br /> CITY OF EVE!;ETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 4�5-257-8810– FAX 425-257-8857–www.evereitwa.org � <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM L�O� /�� I <br /> SITE ADDRESS � PARCEL TAX 1.6.# PERMIT� i <br /> �`l r � �I (; S � S� yo7g •- �i� - o3 �- ono�, � �� � l <br /> LEGAL LOiNO. BLOCK TRACT <br /> oEsc. 3� ss zy �,- 3e /� Cctii�q � /�. !( ���r�.�'+�cN ; l/r.�. � P s3 <br /> OWNER ADDRESS C1TY21P PHONE <br /> C�, sS%� .- O C'•rvd�- C,-��, � /� �i� ''16 '' S� SE � e-. j7 9 �a�3 y�s�3�� -�- ,�y <br /> TENA/NT NAME �J I /� CONTACT FOR PERMIT PHONE <br /> ��h " 31 �'^ � C �^'J� L �t�, ( I .�4�r,.�� L/�S ' .�/ / ' ��"� ��) <br /> d <br /> CONTRACTOR ADDRESS CINIZIP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE I CONTI2ACT PRICE OF WORK <br /> ����� �� J-un. I /\�5���,,.I r �Eleclric _Gas_Other <br /> � <br /> WORK DESCRIPTION � N C �oi <� � �1+� C��^ ��•�� G�NV�2T T� LIVIIJ(y SP4�, <br /> I PLUMf'ING MECHANICAL <br /> I NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilel A/C-air handling units <br /> _ Balhtub Fcrced air systems <br /> _ Lavalory(wash basin) Gas i in <br /> Shower — P n y <br /> — W ater heater <br /> _ Kitchen sink&disposal Gas fireplace <br /> _ Dishwasher Gas ranc�e <br /> _ Clothes washer Clolhes dryer <br /> _ Laundry tray Range hood <br /> Sink(service/badmop/etc.) Exhausl fan <br /> _ BackFlow prevenler Fleat pump <br /> _ Urinal Unit heater <br /> _ Drinkinc� Founlain Boiler <br /> _ Floor drain Refrigeration <br /> _ Grease trap bVoodstove <br /> _ Rocfdrains Olher <br /> Other — <br /> � <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby ceritify tha:I have read and examined lhis application and know the same to be lc,e and correcl All provisions of laws and <br /> ordinaces governing this rype o7 work will be complied with whether specified herein or not The granting of a permit dnes not presume <br /> to give authority to violate or cancel the provision of any other stale or bcal law regulating conslruction or the perTormance of <br /> construction.That I am aulhorrzed by the owner of this property lo perform the work for which applic;llion is made �nd I comply with the <br /> State CoNractO�s La 18.27 RCW and 29620D"V�Ap. <br /> _�- �--,,-. �-� <br /> %� —'����� � :�.- � � "o�' pS <br /> ignalure of OwnedCo�actodAu nzed Agen Dale �/L � <br />