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PERMIT APPLIGATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 — FAX A25-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 7�p 3 —D7 <br /> SITE ADDRESS � PARCEL TAX I.D. ERMIT p <br /> ���� \\LZt1 S"CS.i. Lvece�l �Y�Z� � �' �',- ) ' � �'��-��:)> C7 •. 1 � /��i�_ r'� <br /> LEGAI LOT N0. BLOCK TRACT OR SUBDIVISION N <br /> DESI;. <br /> OWNER ADDRESS CITY2IP PHONE <br /> �o. .��e \c. -� S��c :.� �.�j�La 1'-�3� \\2-�+� S\ SE [../e�e i1" `j5zc'3 (y�513�1 –�II��, <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> � ���s\.33� -�,� ��, <br /> �...�:.�n � `.�c�� �� �c.J Lw `�X> r�;��% �n :�n E�MAIL <br /> I <br /> CONTR.LICENSE U � C>! <br /> �'� �� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��c�-� 5•:. _Eledric __Gas_Olher <br /> WORK OESCRIPTION <br /> L�: :� J c: ����.<�� �o.r c>��C �r�� '�...�a �o��< �O vr.s � <br /> PLUMBING MECHANICAL <br /> NO. � TVPE Of FIXTURE OR I7EM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel NC–ai:handling uni�s <br /> �alhtub _ Forced air sys�ems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower W at�r hoaler <br /> Kilr,hen sink 8 disposal _ Gas fireplace <br /> Dishwasher _ Gas rangc <br /> Clothes washer _ Cblhes dryer <br /> Walor hea�er Ran�o hood <br /> Sink(servicc/badmoplelc.) _ Fxhausl lan <br /> Backllow pravenler _ Heat pump <br /> Urinal _ Unit healer <br /> Drinklnc� Fountain — BO1�0f <br /> Floor drain Relrigeralion <br /> � Grr.aso trap _ Woodslovo <br /> Roo(drains _ Olher <br /> � Othor <br /> I _ — -- <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS�705 <br /> I heroby cerilify Ihat I havo read and Azamined this applicatlun and knew tha snme lo be true and correct. All provisions of laws and <br /> ordinacr.s c7overning Ihis type of work will bo complied wilh whether speciliod herein or nol The yranling of a permit does no�presume <br /> to give authnriry to violale or cancel tho provisiun of�ny other slato or local 12w rogulatinc� construction or tha perlormanco ol <br /> conslruclion, That I am aulhorized 6y tho owner oi this property lo pertorm lhe work for which application is mado and I comply with Iho <br /> S�a�e Conlrar.tors Law 1827 RCW and 296.200 WAC. <br /> �� ��.����A��, co. �v)��-1� � �7 i/ <br /> Signaturo ol Owner/Con�racto u�honzed Agr.nl Dale L <br /> � _ . _ . --- ---- -- <br />