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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM //--/�j-- �D <br /> SITE ADDRESS PARCEL TAX I.D.tt PERMIT p <br /> 3 !i ' S� S�/ (� -v3g <br /> LEGA LOT N0. BLOCK TRACT OR SUBUIVISION M <br /> OESC. <br /> OWNER ADDRESS CITYIZIP PNONE <br /> �'�1R3 �tn� �'H rrca�� l'la7a /�SSo�,,��s POBc� 5�e�,z,Q'/�i��F /� �',�s�fQ�G// <br /> TENANT NAME ��r <{.�y��h,•� CONTACT F/OR PERMIT f'HONE r��;_14�-��U2 <br /> �' �7 �i/�Y�,/1i� /'�/N[.( �-fN Pry r l{�.ji(� ,`{����� E•MAIL � �/��n1•w�.4��cr r L•.r <br /> CONTR.LICENSE p <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> I _Eledric _Gas_Other �j/S� �?`'J�`1 <br /> � <br /> WORK DESCHIPTION ,/�� <br /> L i'I7NNC� � � ��ll ��7 1 �,�{11� ����� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR�TEM N0. TYPE OF FI%TURE OR ITEM <br /> Toilct AIC–air handling units <br /> Oathtub ForceA air syslems <br /> Lavatory(wasli basin) Gas piping <br /> Shower Water hea�er <br /> Y.ilchen sink 8 a:sposal Gas firepiace <br /> Disliwashcr Gas rangc <br /> Clothes washer Clo�hes dryer <br /> VJater he�ater Range hood <br /> _ Sink(sernce/barhnop/etc.) � Exhaust lan <br /> _ �ackllow preventcr _ Heat pump <br /> Urinal Uni�healer <br /> Drinking fountain �oiler <br /> Ploor drain Relrigeration <br /> Grease trap Woo�lslove <br /> Roof drains � Other��1 n� _ <br /> Other __ _ <br /> —I — — —I — <br /> CITY OF EVERETT LOCAL SALES TAX CODE 19 7706 <br /> I hereby certily Ihal I havo read and ezaminuJ ihis application and know ihe same to be truo and correcL AII provisions ol laws end <br /> ordinances�oveming ihis lype ol work will be complied wi�h whelher specified F.erein or not. Tha granling ol a permil does not presume <br /> lo give authorily to vidate or cancel Ihe provision o1 any oth.er state or local law regulating conslniction or the perlormance o( <br /> constructioa Thal I am authonzeA by the owner ol this property lo periorm Oie work lor which application is made and I comply with the <br /> State CoMractors L�w,18 27 fjEW aqd 29f200 W�C. <br /> / i <br /> � � i; , i� /�/��b' ' cl��l� <br /> , '�� <br /> Signature o-y I Owna�Iractor/Authorized Agent ate <br />