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n <br />!� cRMIT APPLICATIVN 5_og_ o � <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 P��j�jJZ ��L ¢ <br />425-257-8B10 - FAX 425-257-8857 - www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ��� <br />S�TE ADDRESS <br />� �J.zG /.1.i�a Q,C J-.EEdi26TT <br />LEGA LOT NO. .2'I BLOCK <br />DESC. P�j��, fF 7�2,t <br />OWNER �I j�� ��iA/F� <br />'�o E y s'K (r <f-2 <br />TENANTNAME � <br />i i ��_ <br />� G(; Jl. l: <br />CONTRACTOR <br />CONTR. LICENSE p L�Cv f�._/ <br />USE OF BUILDING <br />WORK DESCRIPTION <br />PARCEL TAX I.D. A <br />[yo3"39'1aoa6yY° o <br />TRACT <br />P'X �j �i <br />d�—f�t E <br />CONTACi FOR PERMIi <br />AODRESS <br />CITV2IP <br />HEATSOURCE 1,'�:c��/.k< <br />Electnc Gas Olhor <br />; �,• �� ��� � � .f C-� <br />PLUMBING <br />NO. I TYPE OF FIXTURE OR ITEM <br />'� Toilel ----� <br />'+ ' BathWb <br />� Lavalory (wnsh basin) <br />� Shower <br />� Kilchen sink 3 disposal <br />Dishwasher <br />� Clothes washer <br />-- laundry Uay <br />Sink (servicelb�dmo{i�etc.) <br />Backflow preventer <br />Urinal <br />Drinking Founlain <br />Floor drain <br />Grcase irap <br />Rout drains <br />Other <br />ERMIT / <br />S �. — �� <br />\�--r�j'L <br />�����tP��v��.� <br />FNONE <br />PHONE <br />CONTRACT PRICE OF WORK <br />����� �� �� yz. I <br />NO. I TYPE OF FIXTURE OR �TEM <br />A/C – air handling units <br />� Forced air systems <br />!�, Gas piping <br />_L Walor hoaler <br />� Gas firoplace <br />� Gas range <br />� Clolhes dryer <br />Range hood <br />7�l Exhausl fan <br />Haat pump <br />ilnil hoator <br />Boiler <br />Relrigeralion <br />Woodstove <br />O!her <br />CITY OF EVERETT IOCAL SALES TAX CODE IS ]t05 <br />I horoby corilify that I havo road and ezamined Uiis application and know Ihe same lo be true and correcl. All provislons of laws and <br />ordinacr,s �overning this typo of work will be complied wilh wholher specifiod herein or not The granting ol a permil does not presume <br />to givo aulhonty to violato or cancel Ihe provision ol any olhr+r stato or local law regulaling conslruclion or the porfortnance of <br />construction. That I am auUiorized b� lho owncr ol lhis property to porfortn the work for which application is maAo and I comply with lho <br />Stale Contreclors Law 18.27 RCW and 29G.200 WAC. /✓ <br />l- -n7 ' . , /� -/f �f3 ��1.,'ri ��� / <br />Signatur� ol OwnodC ntra I�dAu�-11 n�i 'zod Agart Date � I <br />Z <br />