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t <br /> P�RMIT APPLICATIO�V <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 6 ` ��" `�6 <br /> SITE ADDRESS < PARCEL TAX I.D.l� P RMIT� <br /> (u s o I Ru��� , r� 7 v �Co0 to-U'-1� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> � ' <br /> � 14 Cd�k���- <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> � i ��C LG�G�c iy� /� /�c �oGk1��h4ulN �lck�d��� <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> �?�qv� �o� sC=r�-u C.c�, ?� �uk ss3 ma���t <<,� y�- G7o �� i � <br /> �. .:_K .� <br /> CONTR.LICENSE p ,� <br /> r /�-��� �o�l s N� w,As� 9rbv3 <br /> USE OF BUILDING I HEAT SOURCE CpNTRACT PRICE OF WORK <br /> wv�,p�C (�c7✓ S � _Electric ,�Gas_Other S� (�—� <br /> WORK DESCRIPTION <br /> i z� --�'� J���� s D��-� <br /> PLUMBING M.F.CHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE pP FIXTUF.E OR ITEM <br /> Toilol A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Shower Waler healer <br /> Kilchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas rango <br /> Cbthes washer Clothes dryer <br /> ^ Walcr heater Range hood <br /> Sink(service/badmop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unil heater <br /> Drinkinc� Founlain Boiler <br /> Ploor drain Refric�eration <br /> Greaso lrap Woodslove <br /> Roof drains Olhor <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> 1 hereby ceri;ify that I have read and examined lhis application and know the same to be lrue and correct. All provisions of laws and <br /> ordinac^s c�overninc� this lype of work will be complied wilh wholher speci(ied herein or nol.The grenting of a permit does not presume <br /> to give aut i ity to violale or cancel the provision ol any other slate or local law regulaling conslruction or the periormance of <br /> conslruction. I a I aulhorized by Ihe owner ol lhis property to perform the work for which application is made and I comply wilh the <br /> Stalo Conlr 1 � w 18.27 RCW and 29G.200 AC. <br /> � � / � /� /' '� . <br /> Sig tu e e / n ractodAuthorized A ent Dale <br /> I <br />