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PERMIT APPLICATIOIV <br /> CITY OF EVERE"iT F'�RNilT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www•everettwa.org <br /> `i-16,��' <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> �5"��� 5 1�, PAP.CEL TAX I.D.# PERMIT# <br /> SITEADDRESS �`�L`j 1 or {� � I <br /> �✓�._e.rrt a�._ 1•Y` L' � <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION p I <br /> DESC. <br /> OWNER � <br /> ADURESS CITY2IP PMONE � <br /> � �l0 �'�t�� �.� � ✓ %��3'd� JS 3 � I7 f� � �i <br /> , � ; <br /> .i�l.� J �� IC:t'il^--� �' PHONE <br /> TENANTNAME I CONTACTFOfl PERMIT <br /> E-MAIL <br /> I <br /> •�'�..Y-ia�_ L..S 7 4_ �LS�i1 jL ��4„c ?-"� `l JL-Y'i `I"C)CI Z.. <br /> ' ,�• �-�.��IL Lu,� , i 7LI 7.. <br /> _ 5� i75' <br /> CONTR.l-ICENSE# <br /> } �' :'S Z�' C• CONTRACT PRICE OF WORK <br /> USE OF BUILDING , / HEAT SQURCE I <br /> VEleclric _Gas_Other <br /> WqRK DESCRIPTION (,; (� , <br /> ;�e�rn a L.,s {� y�'.v�� o-�'/��� ►�' � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FlXTURE OR ITEM <br /> NO. TYPE OF FIXTURE OR ITEM <br /> A/C-air handling units <br /> _ Toilet Forced air systems <br /> _ Balhtub Gas piping <br /> Lavatory(wash basin) Water heater <br /> _ Shower Gas fireplace <br /> __ Kitchen sink 8 disposal Gas range <br /> _ Dishwasher Clothes dryer <br /> _ Clothes washer Range hood <br /> __ Water heater Exhaust fan <br /> = Sink(service/bar/moplelc.) � — Heat pump <br /> 8ack(low prevenler � 1 � Unit heater <br /> _ Urinal �t I � 1 — goiler <br /> Drinking Founlain o-��y — Refrigeretion <br /> Floordrain ���\�G'✓1 Woodslove <br /> = Grease trap Jp Q Other _— <br /> Roof drains �6,� 4 — <br /> _ Olher _ — _ <br /> CITY OF EVERE7T LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceritify that I have read and examined ihis applicalion and know ihe same to be true and correcL All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whelher specified herein or not.The granting of a permit does not presume <br /> to give authority to v:olate or cancel the provision of any other stale or local law regulating construction or the performance of <br /> constJuGtion.That I am aulhorized by the owner of ihis property to perform Ihe work for which application is made and 1 comply with the <br /> �tat�Codtractors I_aw�8.27 RCW and 296.200 WAC. <br /> i �, / ? <br /> � �j'P.� i�� Date <br /> �� ignaWre of Ow /ConlractodAuthonzed Agen[ <br /> � -- — <br />