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PERMIT APPLICATIUP: <br /> (:ITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVFRETT, WA 98201 <br /> 425-257-8810 — FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � ��0_�� <br /> SITE ADDRESS PARCEL TAX I.D.# P RMIT# <br /> ., , , , ; .: {:�.,, t��: . ! !�O�SdSG��Ot-�-I�C?O �7 / - .`� j <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION�Y <br /> oesc. OW p -liv ' t� •, <br /> ��` o � • .'t�r.-.r��'-.n 1)� ...:61 m'� � � <br />� OWNER ADDRESS ' CITY/Z!P PHONE <br /> � <br /> ���. . �.� . .... . . �, 1n. ..�_� I_�i!ror�n, 1'.�� IJo`i. ]7FSC� Y�Xr.�T! UY�J� �42:' 75'4'-�iJQ <br /> TENANT NAM�, CONTACT FOR PERMIT PHONE � <br /> 41S-7Sv-33oo <br /> � <br /> �� �' ���, :��' I o+�.���, E•MAIL�lo-��-r i e 4�r,�-h�/�A�. . � <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> � . .. � . . . . .. . j-, r l��„ '::'�Zr� . .,<..,.;5. ,;..ia .'r ' ..�,,, `t -.'i'S `-'p <br /> CONTR.LICBNSE# <br /> - 1- � ' ='f �1 �b� CM <br /> USE OF BUILDING HEAT SUURCE CONTRl,CT PRICE OF WORK <br />� � _Eleclric _Gas_Olher }��,]�h no <br /> YVORK DESCRIPTION � <br /> •— . � '�'A � � Si. ,�' _, _In ✓_it nc•.i.�.a,n a0%ZZ <br /> , ` _ � <br /> 4yuz '3� _ I�,za� <br /> PLUMBING MECHANICAL <br /> NO. � TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handling unils <br /> Bathlub Forced air systems <br /> Lavalory (wash basin) Gas piping <br /> Shower Waler healer <br /> Kitchen sink& disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> _ Waler heater Range hood I <br /> Sink (service/bar/mopletc.) Exhaust(an <br /> Back(low prevenler Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain �oiler ! <br /> Floor drain Refrigeration <br /> Grease lrap Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify lhat I have read and examined lhis application and know the saine to be true and correcl All provisions of laws and <br /> ordinaces goceming this type of work will be complied with�vhelher specified he;ein or not The granting of a permit does not presume <br /> to give aulhority to vieial=.or cancel the provision of any other stale or local law regulating construction or lhe peAormance of <br /> conslruction. That I .�m autyh Ii�zed by lhe er of this property lo peAorm the worh(or which application is made and I comply with lhe <br /> Stale Con aclors Law 18 RGW and °6.�AC. <br /> ��:�� � _n.;� � Il�a����- <br /> Signature of Owner on or tho ed Agenl Dale �� <br /> 7� <br />