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PERMIT APPLICATIOnI <br /> � ���� CITY OF EVERETT PERMIT SERVICES � <br /> }�� B '` 3200 CEDAR STREET, EVERETT, WA 98201 � ` �7 `- (9 <br /> I,_�� � 425-257-8810 — FAX 425-257-8857—www.everettwa.org <br /> �d` � 5 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � �'�J 7Gc ' �), <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# / J1 v/'' <br /> U / l J � � �11�--f� C;J 5�'S�S • Cyrc-<=�`!�cCCB /s -�/D - (/�"V <br /> ` l / <br /> LEGAL LOT N0. BLOCK TRACT <br /> DESC. � c' � � - �j�— �r-✓c} ' l�ol `�/ o� <br /> OWNER ADDRESS CITY/ZIP PHONE ,�,�� <br /> � �1�'c�icZ- ��'�-���--1G.1S�5 �LC �� o���- ?��� A���� C-3�k1�e.l1 .1���14�c1�. 'I 'i3 - i71 <br /> TCNANTNAME CONTACTFORPERMIT FHONE <br /> � • N l.. e S���e,-� <br /> CONTRACTOR ADDR SS CITYIZIP PHONE <br /> �l ���� C��-et���2�s��; ��e. ��c:��.-3s��,;� se 3� �11 �s� ��. y�' � ��� <br /> CONTR.LICENSE# � 1 `� `� <br /> USE OF BUILDING fiEAT SOURCE CONTRACT PRICE OF WURK <br /> 5���`,1`-' �```�1`\`''� ��`�����'`� _Eleclric _Gas ✓Other <br /> � �IU cCx: , <br /> WORK DESCRIPTION �J <br /> � �7'�"�l.�bl-l�� � l�W � �v�'�"i�" �6"'� ✓�--�<<l.t�.{ <br /> `d <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITE�7 <br /> � Toilet A/C-air handling units <br /> �� BathWb � Farcedairsystems <br /> � Lavatory(wash basin) N Gas pipiny <br /> � Sho�ver � VValer heater <br /> J_ Kitchen sinY,&disposal � Gas fireplace <br /> 1_ Dishwasher � Gas range <br /> i Clothes washer � Clolhes dryer <br /> �x_ Water heater � Ranqe hood � m���,�) <br /> Sink (service/badmop/etc.) � Exhausl fan <br /> Backflow preventer Heat pump <br /> Urinal Unit healer <br /> Drinking Founl-ain Boiler <br /> Floor drain Re(ri�eretion <br /> Grease trap Wcodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3'105 <br /> I hereby cerili(y lhal I have read and ezamined this application and kncw the same to be true and correct. All provisions of laws and <br /> ordinaces governing lhis type of work will be complied wilh whether specified herein or not.The granting of a permit does�ol presume <br /> lo give aulhority to violale or cancel lhe provision of any ether state or local law regulaling construction or the performance of <br /> consiruction.That I am aulhorized by the owner of lhis property lo per(orm the work for which application is made and I comply wilh the <br /> Slale Conlraclor; Law 18.27 RCW and 295.200 WAC. <br /> ' ' " w �.�1 y �sti .� � w. S I �1 U L <br /> Signalure o(OwnadConiracl ;/Aulhorized A enl Dale i/y <br /> ( <br />