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PERMIi AP'PLICATION <br />CITY OF EVEF��Ti PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />SITE ADDRESS <br />!�c:"75 li /-{�� Lc/ <br />LEGAL LOT NO. <br />DESC. <br />OWNER <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />PARCEL TAX I.D. # <br />� <br />BLOCK TRACT <br />ADDRESS <br />PERMIT # <br />CITY/ZIP PHONE <br />�civi�:il�ra j(nr� - sc /c�: z� L t .�'�„e_ �-cJ o, ���e�f lci!� i'�''2c �i �/2,��(�� �'yyU <br />TENANT NAME � � CONTAt;T FOR PERMIT PHONE <br />I �/ 2 S ZG; � C�5'�/� <br />CONTRACTOR/ ADDR��SS CITY/ZIP PHONE <br />/t'%1'�lC�i.,''lf�-', f" �S�/j,S' / c�iC. � /Gh- � � S� ri`2c�c; /2-y-/r�<t.z�/ u/1 rj�t,Sy �>� 1 d �S'i "7�jLc� <br />CONTR. LICENSE # <br />/'�/�`'% C. C,f�//�C�l -� �/ ./� << <br />USE OF BUILDING HEAT SOURCE - CONTRACT PRICE OF WORK <br />�� Electric ✓Gas Other �' <br />,� � ; `� f- - - - �� �� l/ <br />WORK DESCRIPTION <br />%� �`�, , _ <br />c, � �c�. t ,r,�, c / ✓� t_ !� ,==c� s � i �-r� 1 u i T-zt� �_ t :��.. .: �yr ,. � l <br />PLUMBING I MECHANICAL <br />NO. � TYPE OF FIXTURE OR ITEM I NO, � 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 />Laundry tray <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 />/ <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 />Exhaustfan <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 wliether 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 re�ulating 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 RCaN and 296.200 WAC. <br />G- jC /C"� <br />orized Apent ate <br />�S a � �/9 /n7 <br />