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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-6857-www•everettwa.org <br /> ^,,��' �'' D!� - �,1 r7 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � ' / <br /> SITE AODRESS P RCEL TAX 1 D.# ��,y,r.r'��� PERMIT!! <br /> ��i s�9��'l�f.,s v+/, %�29�/�'%>�'ml a,6� -- � �o/�- �i�� <br /> LEGA LOT N0. BLOCK �T,���T�_R S����5���. �1 G�O�"��� <br /> DESC. � C� WYCu I' �f' <br /> OWNEH AUDRESS CITY2IP PHONE <br /> L'��61•r✓Fi�"/�'n� /i1�'�'�i�o�F�f CLC y�Zy �—.�G�7 <br /> TENANT NAME CONTACT FOR PERMIT PHONE �'fj'�I,��• �l� <br /> I D•�1NO✓[�/Y"�6��17 E.MAILc�Ct/.tfs�lT�'Sf ;r'/I�%17 � <br /> GyiE��%/oin� �zi�z.5i4 A�%X/�;Sie�.IFi�'�%fr.t7�l�y.�o�/Q82.Y� tafs��J�''S� <br /> CONTH.LICENSE# L�`���,G. /��j�� <br /> f' 7 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ( f � ��cfl° QOC� <br /> f��/E� ������n�+�-iC►'N�CE __Electric �Gas_Other i <br /> WORK DESCRIPTION �� <br /> �Er�,y COi.���lC`7/cp/f <br /> PLUMBING ME'.CHANICAL <br /> Np, TYPE OF FI%''URE OR ITEM <br /> NO. TYPE OF FI%TURE OR ITEM <br /> Toilet A/C—air handling units <br /> y�ly Bathtub � Forcedair:�ystems <br /> � Lavatory(wash besin) .S Gas pipin� <br /> Shower � Water heater <br /> Kitchen sink&disposal Z Gas lireplace <br /> Z Gas range <br /> � Dishwasher � Clothes dryer <br /> � Clothes washer � Range hood <br /> � Water heater Exhaust lan <br /> � Sink(service/barlmopletc.) � Heat pump <br /> Backflow preventer Unit heater <br /> Urinal Boiler <br /> _ Drinking Fountain � qe{rigeration <br /> Floor drain Woodslave <br /> _ Grease trap pther_ <br /> Roof drains -- <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify lhal i have read and examined this application and know the same Ir•be iruc and correct. AII provisions of laws and <br /> ordinaces governing this type of work will be complied wilh whether specified herein or not.The granting of a permit does not presume <br /> to give ority to violate or cancel the provision of any other state or local law regulating conslruction or the perlormance of <br /> const ct n.Thal I am a o ' e by the owner ot t ' property to perform ihe work tur which application is made and I comply with ihe <br /> Sta C tracinrs Law 2 and 296.200 C. / `�/v� <br /> � �/ <br /> S aWre o O ne trac(or ulRonzed ge l Oate <br /> y!� l�i�E� e: �c�ir1E'.S <br /> ,�v <br />