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PtRMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 320G CEDAR STREET, EVERETT, WA 98201 <br /> 425•257-8810— FAX 425-257-8857—www.everettwa.or.c, <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM 'i0 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.M pERM1T p <br /> �� i/�.-�'Si SL-� �C�S'73�-ac�-v39-�i LD"76/ - �7 <br /> LEGAL LOT N05f+ jt BLOCK TRACi /� 1 ,/�/-- C <br /> DESC. i (J�-S J?I- �� /L (� �/tJ�l CI�V J <br /> OWNER AUDRE55 CITYIZIP PHONE /fZg' <br /> G'`A�'� �, ARSi�% ly�c0 ��� c ��. ST ccbU� ' �S-�3'� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> � � � . ��'L��ti�� /�r�i Sr�� l�`��7 ) ��;� -��,�;:� <br /> CONTRACTOR �j� i 1 ���� ADURESS C�TY � PHONE <br /> /ll <br /> CONTR.LICENSE M ' ' � ��!'�� �, � � • <br /> USE UF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> / )/, n/ / Fledric y,,as O�her l �/ K � � <br /> '-�-"/� P'L--G�=� � — --1`�' — .1 �7 ) <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTUFE OR ITEM NO. TVPE OF FIXTURE OR ITEM <br /> � Toilcl A/C-alr handling units <br /> �_ �alhtub _¢_ Forced alr systems <br /> V_ Lavatory(wash basin) � Gas piping <br /> �howm Watcr heater <br /> _,�_ n� � •n sink 8 disposal Gas lireplaco <br /> � Dls� . �hcr Gas range <br /> � Clo!ho� washar '� Clothas dryer <br /> _� Walor hr,alcr �2 Rarge hood <br /> _ Sink (sorvicc/bar/mop/Mc.) �L Ezhausl fan <br />� _ Backllow preveNer Hoal pump � <br /> Urinal Unit hcator <br /> Drinkin� Founlain 9oiler <br /> Floor Arain Ro�riyoralion <br /> Groase Ir�p Woodstove <br /> Raol drains Olhor <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilily Ihal I have re�d and exainined Ihis applicalion and know Ihe same lo bo lrue and conect. All piovisions ol laws and <br /> ordin�ces c�overning�his lyp�ol work will bo complied wilh whalhor specilied horein or noL The granting ot a permil does nol presume <br /> lo oivo authodty to violale or canr�l Ihe provision of any other stata or local law rec�ulaling construclion or lhe pertormance of <br /> conshucli9n. That I :�m aulhorired by Ihe owner of this property�o pedorm ihe work lor which applicalion is made and I r,omply wllh ihe <br /> Stalq-Co iractors Law .27 RCW an 296. WAC. <br /> L • <br /> � ' �: �` , �1l �`l-D(� <br /> Sign re of O e Con actodAuthonzo Agent Dale 1 <br /> �Z- <br /> J <br />