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r ERMIT APPLICATi..1N <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 /> SITE ADDRESS PARCEL TAX I.D.# PERMIT <br /> .3b.L� - zb �� ST. ��� nUSfL85-F2C:C)IOU "� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> ��c�i�.�c� �Zu�l�z., '�L�i-,2��-` sr ap Lv�.�z(� ;4�� 4.�s-�Ii� -1446 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> 4zs-�sy -vr�3 <br /> Tc�(� E-MAIL <br /> NTRP.CTOR ADDRESS CITYI E <br /> 'I�C�. Kc;;('e!G C::L�hZuCiio� J:�c. IL�]- }I....,�l.y„ �„J C�_..iH-.� 4YZY�. YL�-75Y -61u� <br /> CONTR.LICENSE i1 y � <br /> 1'U K c�.[ i `r76 c.5- <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> =�i k��iti E -.= c•,�� _Electric _Gas_Other /Q�,,j� <br /> / <br /> WORK DESCRIPTION <br /> �,�< � <br /> ��...r<i , �z��.�<<�a �,<���� �r�'� ��_ anty (zzxZH <br /> , � , <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet rVC-air handlinc� unils <br /> f3alhtub Forced air systems <br /> Lavatory (wash basinj Gas piping <br /> Shower Waier healer <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sin!c(service/badmop/etc.) Exhausl tan <br /> 8ackflow prevenler Heal pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease lrap Woodslove <br /> Roo(drains Other <br /> Other <br /> CITY OF EVERETf LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify lhat I have read and examined lhis application and know lhe same lo be true and correcL All provisions of laws and <br /> ordinaces governin7 lhis lypc of work will be complied with whelher speci(ied herein or�ot.The granting of a permit does nol presume <br /> lo give authority to�iolate or cancel the provision of any olher slate or local law regulaling conslruction or lhe performance of <br /> construction. Thal I ,im authorized by the owner of lhis propeKy to perform the work for which applicalion is made and I comply with lhe <br /> State Conlraclors La v 18.27 RCW and 296.200 WAC. <br /> -,1�� � ��.� � .-, /��cs,��1,..f ,l��P cp <br /> Signature of Ov+nedContractodAulhorize Agenl Da� <br /> I/� <br />