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t <br /> � PERMIT APPLICATION <br /> '� CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EV[RETT, WA 98201 <br /> 425-257-8810–FAX 425-257-8857–www.evereriwa.org <br /> APPIICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> I� � PARCEL TA%I.D.# �RMIT# <br /> i 51TI:ADDRESS I `, <br /> (� n�fL UIti° /t'�w1Y� 064� 3'�� 336 �'� `lp0 �5��� � <br /> LEG.1L LOT NO. BLOCK TRACT � <br /> DES': I <br /> OWIiER ADDRESS CITY2IP PHONE � <br /> < s„�n: a3.� 5[n-rr� Gi �a( - �( �`6 - � � � � <br /> ���i SS� �:LF, C,En�L�✓.: ,�o c � 1.�c1 H ,�I �- ��s I d � <br /> I� -- CONTACT FOR PERMIT PHOHE I <br /> 7EN�.NT NAME I �.,�l- � _ �h 7 3 � I <br /> I-f r- �L 13t,:,cE� Tlzn �_ s ��n�t>c�-���, � � ✓� � � <br /> CON'"RACTOR ADORESS ITY21P PHONE I <br /> ij � D �� �.J/s Q wNZ^/�j <br /> „e �yL-•� /r 17e ?y- /l �,�i �ij �i AU� . N. , �L - 54 �- 4 �37 <br /> CON'�R.LICENSE�I }_� �,� ,��;,(7 :� � <br /> ���a ,L.r_SA 9SISu SH ��Re L � <br /> U51: OF BUILDING HEAT SOURCE CpNTP.ACT PRICE OF WORK <br /> � ��,�,�,_�"�-- _ <br /> �1�T.�4 $ C, I _Eledric _Gas_Other ��� � j (% — <br /> WOI•:K DESCRIPTION S � <br /> � �R'l3fL.SCI}�TL /}"7`�0 5N TR L ,�.T- t.,= GN h:�._ • tti�o oN d��s�o�-,�G <br /> f -,1� �a i � ��,.,,, a>,,. �-rr u �A-u-"� <br /> :�: SZr.� C' L f. --t�AL[ � <br /> „ , ; � .� � J L{���M1l= N�Tbd] [ n�;�.�r:_r �rG �- r,�. ....-, �� �, .�� N fxi�-r�rG P�tE <br /> ��' �`��""� ��'��E � � MECHANICAL <br /> —� PLUMBING <br /> NO. TYPE OF FIXTURE OR ITEM <br /> NO. TYPE OF FIXTURE OR ITEM <br /> � Toi'�et _ A/C-airhandlingunits <br /> Bathtub _ Forced air syslems <br /> Lavatory(wash basin) � _ Gas piping <br /> Shower _ Water healer <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> I = Dishwasher = Gas range <br /> Clofhes washer Clothes dryer <br /> Laundry tray _ Range hood <br /> � Sink(service�badmoplelc.) _ Exhausl fan � <br /> BackAowpreventer _, Heatpump <br /> Urinal _ Unit healer <br /> Drinking Founlain _ Boiler <br /> Floordrain _ Re(rigeration <br /> Grease trap _ Woodstove <br /> � _ Rooidreins _ Other <br /> i _ Other_ — <br /> � — <br /> GTY OF EVERETT LOCAL SALES TAX CODE IS 7106 <br /> I hei��by ceritify that I have read and examined this application and know lhe same to be true and corted. All provisions of laws and <br /> ordinaces goveming this rype of wo.k will be complied wilh w�rether spedfied herein or not.The granting of a permit does not presume <br /> �' to gi.e authority to violale or cancel the provision of any other state or local law regulating consW dion or the peAortnance of <br /> con: rudion.That I am aulho�zed by�the owner of lhis propeAy to perform lhe work(or which application is made and I comply with the <br /> StaU: Contractors Law 1827 RCW and 296200 WAC. <br /> -�� < <�-�-.-.-T � � 1� o �os <br /> ISgr ature of OvmerlContractor/Authonzed Agent Date <br />