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PERMIT APPLICATION <br /> CITY OF EVERE7T PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257•8810- FAX 425-257-8857-www.everetiwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS ,� PARCEL TAX I.D.N PER N <br /> ga�� - loo Si, S.�. 3 l� � C�� � c�� S <br /> LEGA LOT NO. BLOCK TRACT OH SUBDIVISION 1 <br /> OESC. <br /> OWNEH AOORESS CITY2IP g�ePMONE <br /> YANn,S aM�.sm. �3►�- ���s�, c.E c-�Q��t�, �Q, y�s33�•�a�s <br /> TENANT NAME CONTACT FOR PEHMIT PHONE Q i GL Ou/ <br /> ' QS A��y{ E�IAIL VQn115eG�MCDSf.ncfi <br /> -�L'T l. �_ <br /> �IeFry S� wa� p,e-� P�oX-- qg08�- yar-34&-sa8 <br /> C .UCENSE N �;,�� C���_ 7 <br /> USE OF BUILDIN6 HEAT SOURCE RACT PRICE OF WORN <br /> G ara5{ �( Eler.tric _ _ Gas Olher � 5� q •�� <br /> WO�tK DESCflIPTION <br /> /(� x, L f o�t frnrag t o�• cov�c`-a 1'v pAd Q�� Q�'NS <br /> � �d 6� d• _ ___---> C' �li����� �,�?J� .> � c�..� <br /> PLUMBING ECHANICAL <br /> N0. TYPE OF FlXTURE OR ITEM NO. TYPE OF FIXTURE OR fTEM <br /> Toilot A/C-air handlirg units <br /> Balhlub Forced ei�sys�ems <br /> Lnva�ory(wash basin) Gas pipmg <br /> Shower Water healer <br /> Kitchon sink 8 disposal Gas 6roplar.o <br /> .. . D�shwasher Gasiango <br /> Clothos washcr Clothos dryer <br /> � Waloi healer Range hood <br /> Sink(somcaibarimop/etc.l Exhausl lan <br /> Oackllow prevontcr Heat pump <br /> Unnal / UNI healer <br /> Diinking Fountain Boiler <br /> Floor drain Helrigeralion <br /> Grease irap Woodstove <br /> Roofdrains . Other____,.__._ __ <br /> Olher . - -- �-- --- -- <br /> CiTY F EVERETT LOCAL SALES TAX COOE IS 7105 <br /> I heroby ceriUly Iha�I have read and oKaminvd ihls nppl�caGon and know the samo lo bo Irue and corred. All provisions of laws and <br /> ordinacos govorrnng ttus typo uf work will be complied with whather spectlied horoin or not.The granfing ot a permit does not presume <br /> to grva aulhonly lo violate or cancel ihe prowsion ol any othor slalo or local law regulating construction or the perlormanco ol <br /> consiruct�on. That 1 am authorizal by�ho owncr ol this propoAy to perfomi ihe work lor which applicalion is made and I comply wilh Ihe <br /> Stale Contraqors Law 1827 RCV�and 2962(10 WAC. <br /> 1(.lj�-�/ ;���i'{,�'1' " ��7�Qi`S' <br /> Signafuro �wnnr rnilr ctor/ uthor¢ed Agent . �e �� � <br /> i � <br />