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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 /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS �.�r" PARCEL TAX I.D.# P�RIAIx#'i� �J/� <br /> /��� i�Lr j� K <br /> ��`i�� � G��`tt� C"Vl11AJ(�.. -✓E� r- • —�� � LJ <br /> LEGAL LOTNO. HLOCK TRACT �j.V 'ly� p{-�te{j�,}� �,C TOw-cjl^,i()�`1.(S1J � �� �L <br /> DESC. �� <br /> OWNER ADDRESS CITY2IP PHONE ,.��5 3)�y - I <br /> ��1q..s��fl�,^_�ail���P`� t � l �_ �1'V .� (�Jr'1 ���'VJhCYtili4(f"1 'lad� � 601Y � <br /> TENANTNAME CONTACTFORPERMIT PHONE '' <br /> -N��3lCl� ���1"IL � u; � I f ���l✓L�I� ��i �2� ��� <br /> CONTRACTOR ���� ���b �Y�`�� �`CADDRE�S� �t� CIN2CP PHONE � <br /> �-P�¢,�1 ibUln4-5Ki i <br /> CONTR.LIGENSE C <br /> �iN N �C�000 t�, Q.�p �t la� I o'1 a53 tc�ts- �aab' <br /> USE OF BUILOIIJG I HEAT SOURCE CONTRACT PRICE OF WORK <br /> �y � � C ° <br /> t�� _ElecMc _Gas_O�her t�O(� -�" <br /> WORK OE5CRIPTION <br /> �G�ri, ��.�d�il�"�o ritiiw� Uxt1�, fK�% �-r-�i�iA� U1�l— (�Yu.,�e„ ;�ee-h e{in�;�� � �m+a Curl'-{' <br /> h�e.w Ceu..�{zr a s�n+C �„-., b��¢a�'.rca,.�. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE�R ITEM NO. NPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> Bathtub Forced air systems <br /> Lavalory(v,3sY�r.asin) Gas piping <br /> Shower Water heat=_r <br /> Kitchen sink&disposal Gas freplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> _L Sink(service/badmop/elc.) Exhaust tan <br /> Backilow preventer Heat pump <br /> Urinal Unit healer <br /> Drinking FounlTin Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roofdrains Other <br /> Other <br /> CIN OF EYERETT LOCAL SALES TAX CODE IS�105 <br /> I hereby ceritify thal I have read and examined this applicalion and know lhe same to be irue and correcl. All provisions of laws and <br /> ordinacr.s governing this type of work will be complied with whether specified herein or noL The granting of a pertnit does not presume <br /> to give authonty to violate or cancel the provision of any other state or local law regulating construdion or the perfomance of <br /> conslruc�ion.Tha�I am authorized by the owner of this property to perfoTn the work for which application is made and I comply wilh the <br /> State lrac Law 1827 RCW and 296.200 WAC. <br /> Y n� , <br /> ��� I�V.l, � r Cl. i � ^ -lf-U l.� <br /> S(ig tu e o(Owner//C��ontractodAuth�r ed Agent Date <br /> UY) -��q 1.E.11J'+TLCYIQ'l� �l.`/ <br />