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I <br /> ` I— - — <br /> PERMIT APPLICATInN <br /> CITY OF EVERETT PERMIT SEFcViCES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 -www.everetiwa.org <br /> I APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.N P MIT M <br /> Go7 �� �o�- ���- •.�,;;�ov 7l�/ Z2 <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITVI�lP PHONE <br /> � ` �' -- - — _ 5�.;c3 _ <br /> ,� �� i� ' �c _ rJ ' � �`� -�<i'�r-r::• _.;J ,<: `�:� _ -�1eo31 <br /> TENANT NAME CONTACT FUR PERMIT PHONE <br /> �, .- , .. � ,. ._ -,� i �� i I <br /> � ANf i. 'Ji`., - �_) "7n-..J'yi0� ,",, : i <br /> CONTRACTOR ADDRESS dTYIZIP PNONE I <br /> ���� I <br /> CONTR.LICENSE# I <br /> USE OF BUILDING HEAT SOURCE CONTR�ICT PRICE OF WORK � <br /> , , ; / �:_.� _Electric �Gas _Olher /7�Z��� <br /> WORK DESCRIPTION <br /> �� /p�Z"_ _ <br /> PLUMBING MECF:AMICAL <br /> NO. NPE UF FIXTURE OR ITEM NO. TYPE Of FIXTURE OR ITEM <br /> Toilet /- �� A/C-air handling units <br /> T Bathtub � -� Forced air systems <br /> -rt Lavatory(wash basin) /% ' � Gas piping <br /> _.,_ Shower, _t Waterheater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher _� Gasrange <br /> Clothes washer ! Clothes dryer <br /> Water healer 1 Range hood <br /> Sink(service/bar/mop/etc.) Exhaustfan /�/� <br /> Back'I»w preventer � Heat pump <br /> Urinal Unit heater <br /> Drinkiny Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap � Woodstove <br /> Roof drains Other � <br /> Other <br /> I qN OF EVERETT.00AL SALES T/U'CODE IS 3105 �I <br /> iI hereby ceritify that I have read and examined this apNiication and know the same to be true and cortecL Atl pro�isio�is of la::�and ��' <br /> ordinaces governing this rype of work w�ll be complied with whether specified herein or nol.The granting of a permA does nol presume �i <br /> Ito give authority to violate or cancel the provision of any other state or local�aw regulaling constructlon or the per(ortnance of ,.' <br /> construction.That I am authorized by th2 owner of this property to pedorm the work tor which applicafion is made and I comply w7th the <br /> Stat ontiactors Law 1827 RCVJ and 296.200 WAC. <br /> �� � + II <br /> �a.� � � r���,� <br /> Signature oi OwnedContractor/Authorized Ac�ent Date <br /> YL <br />