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1 <br /> P RIIAIT APPLICATION <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 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT <br /> I W �As'�a�� �h'D - }4 odd651 D lol Q 70�- �; <br /> LEGAL LOT NO. BLOCK TRACT OH SUBDIVISION N <br /> OESC. <br /> OWNER ADDRESS CITV2IP PHONE <br /> �Mt.�RSE'r �i�.k C�NooM�nl;�Ms ►4?� �1Cpst►�b 1� �f�tC °►82a4 <br /> TENANTNAME CONTACTFORPERMIT PHONE � fpdZ �ZII <br /> ��stc" �Akk I JiM`�(ae�� �'L8� ���-Ma��tr►ek�lv�waeala�xs. <br /> carmnri .�.�D � <br /> CONTR.UCENSE R <br /> USE OF BUILDING HEAT SOUFiCE CONTRACT PRICE OF WORK <br /> (,0��1�'���}�� I , __ Electric __Gas__ ._Other � ` ���� �— <br /> WORK DESCRIPTION <br /> ��t(E � �G�LNL6 S�I�� � � P.�LP�rs(p L►.lJ��` Rdf{�1nRS <br /> PLUMBING INECHANICAL <br /> NO. TVPE OF FI%TURE OR I?EM N0. TVVE OF FUCTURE OR ITEM <br /> Toilel . � � � � ' ' � • . � ._ _ A�C—air handGng units ' � <br /> �athtub ___� Forced air syslems <br /> . _ Lavatoiy (wash basin) ____ Gas piping <br /> Sho�va __. Water heater <br /> __ KitGien sink 8 disposal _ __ Gas fireplace <br /> Dishwasher ___ Gas range <br /> Clothes washei .. . Clothes dryer <br /> Water heatcr _. Range hood <br /> Sink�sr.rvice�bar/mop�etc 1 _ Exhaus�lan <br /> _ Backllow prevenler .__ Heat pump <br /> Urinal ___ Unit heatcr <br /> __ Drinking Founlain ___ Boiler <br /> Flocr drain __ Relrigeration <br /> __ G�case trap Woodsrove <br /> Roofdrains __ O�her <br /> --- Other _. .---- - - <br /> CITY OF EVCRETT LOCAL SAI ES TA%CODE IS 3105 <br /> I heieby ceritify that I hara read and examined ihis application and know the same to be true and correct. AII provision.s ol laws and <br /> ordinaces goveming Ihis type ol work will be complied wilh whelher specilied hdrein or not.The granting of a permil does nol p�esume <br /> to give aulhority lo violate or cancel the provision of any olher state or local law regulating constructio.�or the pertormance ol <br /> constiuction. That I am autliorized by the owne�of ihis property to perform Ihe work lor which application is made and I comply wilh the <br /> St Coniractors Law 1827 RCW and 296200 WAC. �? <br /> � Us 23 <br /> � nah e of O �er� onlractorAulhonzed Agent — - ale -- <br /> .. . ... _-------- __ _ --- I I� <br />