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� <br /> �ERMIT ARPLICATIt�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERE'(T, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FRO�d 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# � PERMIT# <br /> tia� '��c� -, .� � So S i 1 - OU� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. �{��1 k �.}} I.I.� N,� <br /> OWNER `'���r �� ADDRESSC���� {{ CITY2IP PHGNE <br /> \ �� � CC. _, , - � ,�v,a • S'4�Z�.�<< <br /> �lJ���G�l'` .1.�Clr.��-t+�.0—� L��c, � � LL C_ �'-5 _ -�2.5-i�i-2£i <br /> TENANT NAME I CONTACT FOR PERMIT c..{�.s RHONE "�j"�Q.-Z���`�� <br /> S(��w�� f-l-�'j;,�1.7�. �.P:�'r� 1cie.l E-MAIL �['c�iS�-tic. d�'- TE. <br /> CbNTRACTOR ADDRES�§� CIN/Z—1��FlaT '� <br /> �P -�-��-�-�S'_�=%-"• �lG S �� r��r��w,� �=c;�� 3 SS- �S o 0 <br /> CONTR.LICENSE# <br /> USE OF BUILDIPIG HEA7 SOURCE CONTRACT PRICE OF WORK <br /> ��--��C� ��.���L p, \ _Electric _Gas_Other <br /> WORK DESCRIPTION , <br /> Cl��t l�a// �' s <�-��� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> Balhtub Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Shower Water heater <br /> Kilchen sink tL disposal 6as fireplace <br /> Dishwasher Gasrange <br /> _ Clothes washer Clothes dryer <br /> Water healer Range hood I <br /> Sink(service/barhnop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Re(rigeration <br /> Grease trap Woodslove <br /> Roo(drains Olher <br /> Olher <br /> CITY OF EVERETT LOCPL SALES TNC CODE IS 3105 <br /> I hereby ceritify thal I have read and examined Ihis application and know the same to be true and correcL All provisions oE laws and <br /> ordinaces governing lhis type of work will be complied with whelher specified herein cr not The grantiny of a permit doas net presume <br /> to give authorily lo violate or cancel the provision o(any olher stalr,or local law regulaling construction or t:�e peAormance of <br /> conslruction.That I am authorimd by the owner of lhis property to perform lhe work for which application is made and I comply with the <br /> Slale�C�o�nlr�aclors La�w 27 RCW and 296.20 AC. <br /> — �--� '�`1 /!��?`�/�1r�C�� <br /> Signature of OwnedContrac Authorized Agent ` Date <br /> � � <br />