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P�RMIT APPLICATILnI <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 /> —�7��s�h�, A�� APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS � Q �V�' C�110 ( PARCEL TAX I.D.# PERMIT# <br /> : ,l� � ��� ��_; � �� � _ �i ! <br /> LEGAL LOT NO. BLOCK TRACT OR SUODIVISION p <br /> �ESC. <br /> OWNER AUDRESS CIN/ZIP PHONE <br /> TENANT NAME CONTACT FOR PERMIT I I PHON 1 oG yil- S <br /> rl�(A�,�I(f � . IILI E-MAIL <br /> 13 i K L' U-�G;1�t n�I GY'� ,z�—�uau�— <br /> p,�, . �OxGz�-I F�,F�a�w�� <br /> CONiR.LICENSE p 6�.� ��.� � �l� ��0�� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � /�Eleclric _Gas_Other � � I � O�\ . t�� <br /> WO KDES�RIPTION <br /> 7tir,c- ����c' N�;, �;�� sboh' �:�.cJ (��i, r� �006"�+^� . <br /> � .�, � , <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIX7URE OR ITEM <br /> . <br /> Toilcl A/C-air hnndling units I <br /> I [�,�p��ii�� Forced aY systems <br /> I _ Lava�ory(wnsh basin) _ Gas pipiny <br /> Shower _ Waterheatcr <br /> _ Kilchen sink 8 disposal _ Gas Ivoplace <br /> Dishwasher __ Gas ranye <br /> � Clolhes washer Clothes dryer <br /> Walcr healcr Rango hooA <br /> _ Sink(servicelbarlmoplolc.) _ Ezhausl fan <br /> I — �ackllow prevenler � Hcat pump <br /> Orinal Unil heater <br /> � Drinkinp Founlain Boilcr <br /> Floor drain Rofriyera�ion <br /> Grcaso Irap _ Woodslove <br /> Roof drains Olhcr <br /> Olhr.r _ - <br /> I <br /> I - <br /> CITY OF EVERETT LOCAL SALES TA7(CODE IS J705 <br /> I hereby cerilily Ihnl I have read anA oxamined�his ;ipplication and know Iho same to be truo and corr[rcl. All provisions of laws and <br /> urdinaces governinp Ihis typr,ol work will ba complied wilh�vhuther specilmd herein or nol The c�ranting of a permil does nol presume <br /> lu yivr, aulhority lo violale or r.ancel lhe provision ol any ulher sla�e or bcal�aw regulating consiruclion or Iho performance ol <br /> icunslruclion. Thal I am � ulhuritedby t ie owner o�ihis propeny lo perfonn Uie work for which applicalion is made 2nd I comply with ihe � <br /> Slale Contractors Law �.27 R � A 29G.200 WAC. I <br /> i <br /> ' � � .:' - _--,�-- ��y/ T i <br /> `-�— ic7nature oi OvinedContre ou ulhorized Agonl Dale � <br /> I <br /> . . __. .. _ --- � - -- . ..—_ .. _ . — -- � <br />