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SITE ADDRESS <br />l lv G�G /y1� rv`;1l ��r . l�k �.✓ <br />DESC. <br />OWNER <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 <br />o� <br />PARCEL TAX I.D. # <br />TRACT OR SUBDIVISION # <br />ADDRESS <br />PERMIT # <br />�`}j2 -vl <br />� �-� <br />Cy�l'/�.i1�77[�7►Iq <br />Lo-f � c �.�- � ��j'o� 22"� a.,��. �1 C,;. ���or-w�.I: �,�� `�rh'/(C� C2d�)5`�L-5'9c�s <br />�T/E� tA�l� NAMa fW,,n %`,z `� f �y� CONTACT FOR PERMIT PHONE/'�Z�1 7Sy, 3�'2 <br />f i.t � ::� � C � <br />��UC�, ����.. `-{�4 � ��t �� 1-t f i[ rt:"ldX��. E-MAIL��ra n�an� "ftc{�Uc.C`�' <br />CONTRACTOR .�,.,-r��Y4� � ADDRESS CITY/ZIP PHONE <br />0��� �, <r- ��,t\ b� cfai/� f�i'i. wc' c B� w/�'�-1-errt�� �a �vr l�e �i�n��a�-�vr � i ��d <br />CONTR. LICENSE # ! <br />USE OF BUILDING <br />HEAT SOURCE <br />�«�; ,;,.k ; , �, t- � �� / _ Electric � Gas _ <br />WORK DESCRIPTION �,� i ( �{ Q„��( (� �� C_�;� �f /D � ,��( <br />� � �a f � �r; ' . . t�n,) : r . �� C �- � '.� r� J � . {� �t : F� <br />-' i <br />Other <br />I�I� �OtsGf <br />CONTRACT PRICE OF WORK <br />� � �Q7 . Ud <br />'1"`f:��+*` asc( �2 <br />PLUMBING I MECHANICAL <br />NO. I TYPE OF FIXTURE OR ITEM I NO. I TYPE OF FIXTURE OR ITEM <br />Toilet <br />Bathtub <br />Lavatory (wash basin) <br />Shower <br />Kitchen sink & disposal <br />Dishwasher <br />Clothes washer <br />Water heater <br />Sink (service/bar/mop/etc.) <br />Backflow preventer <br />Urinal <br />Drinking Fountain <br />Floor drain <br />Grease trap <br />Roof drains <br />Other <br />A/C — air handling units <br />Forced air systems <br />Gas piping <br />Water heater <br />Gas fireplace <br />Gas range <br />Clothes dryer <br />Range hood <br />Exhaust fan <br />Heat pump <br />Unit heater <br />Boiler <br />Refrigeration <br />Woodstove <br />Other <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinaces governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br />to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br />construction. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br />State Contractors Law 18.27 RCW and 296.200 WAC. <br />�� <br />':�!-a.c ��--,�.�-��f-��� �_ � ia/�a /, � <br />Signature of Owner/Contractor/Authorized Agent Date <br />