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� � <br /> PERMIT 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 X r U�—C%C�I <br /> C� <br /> SITE ADDRESS PARCEL TAX I.D.# P MI N <br /> :!7�1 c���;�v.�� 1t�;E. �C _;-:,� t � �:t. c ,F<_�� ../ _ <br /> LEGAL LOTNO. BLOCK TRACT � <br /> DESC. <br /> OYYNER ADORE55 CITY2IP PHONE <br /> :��L:�:y�'�. _i �i�L�- i�7:�1 �`�L�.CY�'.� �� t�rc�e� i� <br /> TENANT NAME ;.ONTACT FOR PERMIT PHONE <br /> �-�-�cz�:�� ;,� I �.��,C� �� ,,�.�< < ���� - :�.7-Zx�� <br /> CONiRACTOR ADDRESS CITYIZIP PNONE <br /> �Z-�I-C- '_-C�_r�`,� ZtT��L��.:-.��c.•� '�,�"Y_ '�E 1'S} �i itA�LE_ c.�A ClFS�� <br /> ;:ONTR.LICENSE t J <br /> C�'��`7�'T (2c-C'> 7L- 7' ��N-� <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Eledric �Gas_Olher ��,�j ���;� <br /> WORK DESCRIPTION �[_���%�c !: tXIS��JG \�;��.L�C 1��C-� ��'�.c:�L` 'e-E :�Ar Et�- - <br /> � 1�CL�L Y <br /> 'v�l_Ji� �. 1�:.C�L-K�n � �i4_Je^'-�E (,'/ l_�C�> >=r��lr.��. ��ba .iiF`..��i_•._� <br /> c;:.cE�`; ��t.L�t-�_ �`"_��� �� •3�V f�r�.'� ',>�Ev�.,.�"c't. ,. S <br /> ��, ,E ,`t� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TVPE OF FIXTURE OR ITEM <br /> _ Toilet A/C–airhandlin�units <br /> _ Bathtub Forced air syslems <br /> _ Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> _ Dishwasher Gas range <br /> _ Clothes washer Clothes dryer <br /> _ Laundry tray Range hood <br /> Sink(servicelbarlmopletc.) Ezhaust fan <br /> _ Backflowpreventer Heatpump <br /> Unnal Unit heater <br /> _ Drinking Fountain � Boiler �,S�^��• l l i;�;�1 <br /> _ Floordrain P�;,igeratIDn � <br /> Grease trap Woodslove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> i hereby ceritify that f have read and examined ihis application and know the same to be tnie and conect. All provisians of laws and <br /> ordinaces goveming this lype of work will be complied with whether spedfied herein or not.The granting of a pertnit dces not prescme <br /> to give authonty to••iolate or cancel lhe provision of any other state or lowl law regulating construdion or the performance of <br /> construction. Thati.un authorized by the owner of this property to peAortn the work for which application is made and I comply with the <br /> State�ontractors Law��27 RCW and 296.200 WAC. <br /> \ .-- � � \` � � �c��. <br /> Sgnature of OwnedConiradodAuthonzed Agent Date <br /> � <br />