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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES S 31 ��7 <br /> 3200 CEDAR STREET, EVERETT, WA 98201 �. )} 'f <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org J "��C � <br /> APPLICATIONS ARE .4CCEPTED FROM 8 AM TO 4 PM <br /> IC���;� <br /> SITE ADDRESS PARCEL TAX I.D.# PE�R/td1T it <br /> /')Ofs Gro�e� �✓n. GU9• 3 �2 3S-/J:�1 �C X./7�_�_� <br /> LEGAL LOTMO. BLOCK TRACT <br /> DESC. L� &3u 3s� D <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> �iA I✓� 1�w� I�10G bra� ��-'a� F.verr,b! f�A- �1�� I <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> ;\�� �c�� M;<< K,� z�6 -q�� - G�i3 <br /> CONTRACTOR �I— ADDRESS CITYlZIP PHONE <br /> CONTR.LICENSE# � )�V Jr <br /> V I <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> t�tny Co.re- I �Eiectric _Gas_Other I .4�1 <br /> WORK DESCRIPTION • <br /> �����,��, ����:./�,���►1� � ��y �E�� v <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A!C-air h mdling units <br /> Bathlub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal _ Gas tireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clofhes dryer <br /> Waler healer Range hood <br /> � Sink(service/badmop/elc.) �_� p��� _ Exhaustfan <br /> Backflow prevenler "� _ Heal pump <br /> Urinal Unit heater <br /> Drinking Faunlain _ Boiler <br /> Floor drain Refrigeration <br /> Greasetrap _ Woodstove <br /> _ Roof drains � Other <br /> Olher ocr r <br /> — _ _/_ Rnr+r�ti� <br /> CITY OF EVERETT LOCAL SALES TN(CODE IS J105 <br /> I hereby ceritify Ihat I have read and examined this application and know the same to be lrue and correct. All provisions of laws and <br /> ordinaces goveming lhis lype of work wi�l be complied wilh whether specified herein or noL The granting o(a permil does not presume <br /> to give aulhority lo violalo or cancel the provision ot any other state or local law regulating consWction or the performance of <br /> conslruction.Thal 1 am aulhorized by the owner of this property to perform the work for which application is made and I comply wilh the <br /> State Conlreclors Law 18.27 RCW and 296.200 WAC. <br /> 5-/ `l. <br /> /b�.r ril�• ��% �}``- ��7 - <br /> Signatu�e'of OwnedContractor/Authonzed Agent Date <br /> I/z <br />