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PERMIT APPLICATiON <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810– FAX 425-257-8857–www.everettwa.org <br /> APPLICATIUNS ARE ACCEPTED FROM 8 AM TO 4 PM 3 —I I '"� <br /> SITE ADDRESS PAHCEL TAX I.D.# P MI7# <br /> Oa-l� i9*" �5E f�elDl �, '2,- O(� <br /> LEGAL LOT NO. BLOCK TRACT Ofl SUBDIVISION p <br /> oesc. <br /> OWNER AD[`RESS CITY2IP PHONE <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> ,SI ��. A/1LliN[a�n�f. �.t��� Al/� �a�"��Lne/ E-7.IAIL � QA"O�l $CQtQ . <br /> �4a.wk.Co�s-t,��z�. p.�. � aa�S �1o�nw�u� 4ga�a� ev�-, <br /> CONTR.UCENSE k <br /> t{A wK.�3C.i- oa 4prn <br /> USE OF BUILDING HEAT SOURCE CONiRACT PRICE O�WORK <br /> �,y�i I _Eleclric __ Gas__Other �I7JcF ��', `� <br /> Ji <br /> WORK DESCRIPTION �yµincph�QGC.Q '[T � yL0{�,.�J� ,5'd�L¢' � �(if(��j�N�. �(5��� <br /> �L°r�Gi2 G , �c.ou�/!�-���C�2-����.c��-a� � �x-ove-t,Gl-�- <br /> �J <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet FVC—air handling unils <br /> Bathtub Forced air systems <br /> � Lavatory�wash basin) __ Gas piping i <br /> Shower _ Water heater <br /> � � Kitchen sink 8 disposal __ Gas fireplace <br /> Dish�vasher __ Gas range <br /> Clothes washer __ Clothes dryer <br /> Water heater Range hood <br /> � Sink(servicelbarlmop/etc.) _ Exhaust fan <br /> Backflo�v preventer _.___ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> � � Floor drain __._ Relrigera�ion <br /> � � Grease lrap __ Woodslove <br /> � � Roof drains ___ Olher---_- ----.- - <br /> Olher <br /> CITY OF EVF_RETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritity Ihat I have read and ezamined this application and know the same to be irue and correc�. All provisions of laws and <br /> ordinaces goveming ihis rype ol vrork will be complied viith whether specified herein or noL The c�ran�ing ol a permit does no�presume <br /> to give authority to violate or c.ncel ihe provision el any othu state or local law regulating construction or ihe pedormance of <br /> consiruction.That I am autho i�ed by the owner of this property to perform ihe work for which application is made and i comply with�he <br /> State ontractors La �18. �CW and 296.200 WAC. <br /> � � ` //C/w� �� � � / <br /> Siglf r of Ownerl onliactodAuthorized Agent Da / <br /> � <br /> G_' <br />