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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STRCET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 - www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FR(`M 8 AM TO 4 PM q �-�{�D7 <br /> SITE ADDRESS PARCEL TAX I.D.k PERMIT p <br /> /..?i-7 ��J[i�v��✓i N J�.-f-'EE%' �30�G�i U I C <br /> LEGAL LOT NO. BLOCK TRACT OR SUBD�VISION M <br /> DESC. <br /> OWNER ADDRES° CITY/ZIP PHONE <br /> f/HE,Ci cfJ•� �a�G,�oA� /1/Z �i� �/ibKa.•if1 .Sr,e. ��F��� S�-Z�� -tS`�'� 79� <br /> TENANTNA�IE CONTACTFORPERMIT PHONE �2J _2�A_I � !� <br /> 1� �- �O� <br /> /`K�.�'-/c v,l ��s.i b c� ���CS'1 �� .,51 �r�. E•MAIL <br /> �6ry�g� �TTVISIP <br /> CONTR. UCENSEp <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Eleclri,; Gas Olher <br /> WORK DESCRIPTION . <br /> _—l�v,�„�'� �o.�' C O <br /> i <br /> PLUMBING A�ECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A�C--air handlinc� unils <br /> 6athlub Forcr.d air sys�ems <br /> --- Lavatory (wash 6asin) _ Gas piping <br /> Showcr Waler healer <br /> Kitchen sink 8 disposal _ Gas fireplaca <br /> Dishwasher Gas renge <br /> Clolires washer _ Clolhes dryer <br /> Watcn c�alcr __ Rango hood I <br /> Sink (servicelbar/moplolc.) _ Eahaust lan <br /> Backllow prmenter _ Heat pump <br /> Urinal Unil hoa�er <br /> Drinkinc� Fountain _ �oiler <br /> Floor drain Relriyaralion <br /> Grease trap _ Woodslov�t <br /> ' Rooldrains Olher ____ <br /> � Olhc�r _ — — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> II herehy cerilily lhat I have read and examinr,d ihis applicalion and know tho same to be�rue and correcl. All provisions of laws and <br /> ordinaces 9ovemin�Ihis lype of work will be complied with whether spociliod herein or noL Tho yran�ing of a permll does nol prosume <br /> to yive aulhorily lo violalo or cancel Iho provision ol any other sla�e or local law requla�ing consiruction or the perlormance of ! <br /> conslrur.tiun. Thal I am authorized Ly the ownor of this property to perlorm Iho work lor which application is made and I comply with the I <br /> i �ta1c Conlraclors Law 1H27 RCW and 29ti.200 WAC. I <br /> i ,/�.7 �%.-s�,��...�/i.tii�L. �- /J�% LrJ <br /> Sipnaluro of OwnedConiraclodAulhorized Agenl Date �7 <br /> � l <br /> I . . .. . _. _ __._ _ — _.__---- ----- � <br />