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, i _pc <br /> PE�MIT APPLICATI4�� <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 - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# C���I3JS�7.3��G0� 2 pERMIT N <br /> !. � �o � << �� c -� 3� c � al Ly -3� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> �i�c � �' ;c (�-v� Sw�-eJ�w�c��r'S 13�G F'rrc, � �cnv< sWk � ��o.�+t, �•,ro <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> l h 6�wr S <br /> C�P �. �vr� �cl�a �nJa�tlLs' S4QVe �-��l�t'�t I �'�1Trto �-c�r�Hy (yz�J77/-0� 2�XZ <br /> CONTRACTOR AD RESS ¢ITY7�IP PHOHE <br /> �1i�t�co Co�s�iY �<<�-�U� �a,� C�(z�)�7�-o9z6 <br /> CONTR.LICENSE# <br /> WCSroc , - � I'v�soy �co3 � � � i,,rc b✓it 9�n�/b X �3) <br /> USE OF BUILDING HEAT SOURC CONTRACT PRICE OF WORK <br /> 0 <br /> � a� ([°,� Electnc �Gas Other � <br /> 11�- r. G -{—�—,�l.1�✓z — _ , �ov� <br /> WORK DESCF IPT70N <br /> �idSl•r�cc. � CcrS,at ��yrsl��-.S �5�2ntN/I1 �CL�✓}�•PIC/Y� (�t-rrr��' <br /> ��.� �,� �dYi i iuy l� �-0 ('WSkr���' �Cd� ��t� !YZC_Ciulr�l°(•�hcrc�� 7Vi��>CI �P� f� /1��2 , <br /> �Mn_��Nti�' (L,s�r�- vy)� V.f�,cJc Sl-�-�,c�� wr'{-1� (J-�rs Cr4e �4j✓o i1e tNrtY> pc;r(-i°'c� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> _ Bathtub Forced air systems <br /> Lavalory(wash basin) = Gas piping <br /> Shower W2ter heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Distiwasher Gas range <br /> Clothes washer Ciothes dryer <br /> Laundry tray Range hood <br /> Sink(service/barlmop/etc.) Exhaust fan <br /> Backflow prevenler Heat pump <br /> Unnal Unit heater <br /> �rinking Fountain Boiler <br /> Floor drain Refrigeration <br /> _ Grease trap Woodstove - <br /> Roofdrains � Other W(�GLSG}fvl� w� 1�� ��?ff�. ��U�hti� <br /> � Cther <br /> � — — <br /> I <br /> ICITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> I hereby ceritiry that I have read and examined this applicatlon and know the same to be true and correct. All provisions of laws and <br /> ordinaces go�erning this rype of work will be complied with whether specified herein or not.The gra�ting of a permit does not presume <br /> to give au onty to violate or cancel the provision of any other state or lor.al law regulating construction or the performance of <br /> consiructi ,S authorized by the owner of ihis property to perform the work`or which application is made and I comply with the <br /> State � tractors Law 1 RCW and 2�6.200 WAC. <br /> � ` 6 � �- o-O <br /> Si ur o wneuConlractorlAuthonzed Agent Date <br /> � �I'L <br />