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. -- -- ----- --- <br /> --- <br /> ,------ - <br /> I PEl�lVIIT p;PPLl�ATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET. EVERETT. \NA 98201 <br /> a25-257-8810 - FAX 425-257-8857 - v,hv�v.ev�rethva.org <br /> i APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM I - aS-ID <br /> � - ERMIT it <br /> � SITE ADDRESS PARCEL TAX I.D.# <br /> � ��� ti,y���� � � ��Ul�-�S <br /> I LEGAL LOT NO. BLOCK TRACT OR SllBDIVI5104# <br /> DESC. _ <br /> OWNER ADDRESS CITYIZIP PHOtJE <br /> �� — tiZs–av�– z.3`�3 <br /> ( � �_r��u �c.�����,..,-,.–�v-�. <br /> TENANT NAMF CONTACT FOR PERA7IT PHONE <br /> 1"V�-�...:,v\� � �� � \ I I l/LJ l�Sn `�L E•MAIL I <br /> ONTRACTOR ADDRESS CITYIZIP PNONE <br /> CONT�R.LICENSE# `R��� <br /> Ql]/ <br /> US[ OF 6UILDING I — FIEAT SOURCE I CONTRACT PRICE OF WORK <br /> Eleclric G2s Olher <br /> VVpRK UESCRIPTION <br /> - I <br /> � I <br /> I _ ��°C_I.�C.,,�,_�[.,,P _ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE CR ITEfd <br /> NO. TYPE 0� FIXTURE OR ITEM I <br /> Toilet _ aC-air handling unil, <br /> Rathlu6 _ Forced air syslems <br /> Lavalory(�vash hasin) _ Gas pipinc� <br /> IShower _ W:�ler heatcr <br /> Kitchen sink R dis��osai _ Gas fireplace <br /> � Uish��vasher _. Gas ranc�e <br /> Clothes washer ,_ Clolhes dryer <br /> � Water healer _ Range hood <br /> Sink(serviceNadmoplelc.) _ Exhaust tan <br />'� — Heal pump � <br /> � _ 6acktlow preventer Unil healer <br /> i I _ Urinal Boiler <br /> _ Drinking Fountain �efrigcralion <br /> Fluor drain Woodstove <br /> Grease trap Other I <br /> Roof drains — <br /> Olher — '— <br /> � <br /> i CIT1'OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby cerili(y that I have read and ezamined lhis application and kraw the same to be true and correcl All provisions of laws and <br /> � ordinrres go��erniny Ihis lypo o!work will be complied with whether specified herein or nol The granling of a permil does no!presume <br /> �It�gi�e authorit�!u viclaie or cancel Ih:=provision uf any uther stale or local law rrauiatinp mnstruction or Ihe pertormance of <br /> � construction.i hal I am 2�ulhonzed by lhe owner o(this property lo periorm tho wcrh(or which applicalior.is made and I comply with the <br /> � Statc Contractors Law 18.27 RCW and 29u.20D WAC. <br /> SignaWre of OwnodContractor/Aulliorized A�ent Datc \ �� I <br />