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��r�lC � �� <br /> ,,. _ , , - ---- _ <br /> PERMIT APPLICATION ' <br /> CITY OF EVERETT PERMIT SERVICES <br /> � 3200 CEDAR STREET, EVERETT, WA 98201 I <br /> 425-257-8810- FAX 425-257-8857 -www.everettwa.org I <br /> � � <br /> � APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � —� �-(`I� �I <br /> Ili SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> � �c� ��l`�, ��,'� � �` J ' �D�D� -Go � <br /> II LEGAL LOTNO. BLOCK TRACT 1 <br /> � DESC. 1 i v\� ' ..v�.. �. . L� Q - ��` . .)_ .�l�:� �- 5 �,.. , I� <br /> OWNER ADDRESS CITV/ZIP PHONE <br /> C��� ���1 L����7� �-1 l�,- \�c�1�`: \�v���. ,��� lk?a <br /> 7ENAN7 NAME CONTACT FOR PERMI7 PHONE ��x�,� <br /> ���- �SS-��� � `�-- <br /> CONTRACTOR , (A�DDRESS , / �� �, ; CITY2IP ( PHON� / ,(� <br /> ������ L��+v�yt�C—� �',t.���.�5� �1 �C3 �L� vY��C '_�� ��(:Cvf�t� �lvG�. �t �I,�:'� c� <br /> I CONTR.LiCENSE# 1 ` t / i 1 p L�� ^-� l�. ('j <br /> 1�r�\�`C..�'.��I�-�C'\�-\ .�1 j"'l l_li.� \�7`c�-' C�'��;` `�`"\,`�C% <br /> k <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> . �� �.�� <br /> ����, ���i � � —��-�L� �Electric _Gas_Other �,_� ��;��---�-- <br /> WORK DESCRIPTION � `� � �-�� <br /> � rt��.<eLC -�� �s��- ����v�-�� � Clr�.'�..-�t���L�( ��z— ���?� <br /> �LL�.,L.� �.`�: �,_��.�_ <br /> PLUMBING MECHANICAL <br /> NO. 7YPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR I7EM <br /> Toilet AIC—au handling units <br /> _ Bathtub � Forced air systems I <br /> Lavatory(wash basin) Gds piping <br /> Shower Water heater � ��. <br /> _ Kitchen sink&disposal _ Gas fireplace � <br /> Dishwasher Gas range <br /> Clothes washer Cbthes dryer <br /> Laundry tray Range hood <br /> Sink(servicelbar/mop/etc.) Exhaust fan <br /> Backflow preventer � Heat pump <br /> _ Urinai Unit heater <br /> _ Drinking Fountain _ Boiler i <br /> i Floor d�ain Refrigeration <br /> �� _ Grease trap . Woodstove <br /> ! Roof tlrains Other <br /> Other <br /> i — — — — <br /> i _ <br /> � CITY OF EVERETT LOCAL SAIES TAX CODE IS 3705 <br /> �� I hereby centify that I have read and examined this application and know the same to be true and correct. AI�provisions of law�s and <br /> � � ordinaces goveming this type of work will be comphed with whether specified herein or not The granting o(a permit does not presume <br /> ��. to give authority to violate or cancel the prowsion of any other state or local law regulating con,truction 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 t comply with the <br /> State Contractors Law 18 27 RCW fid'296 200 WAC <br /> i __- ,, , , � --�� `_ _ � ��/c <br /> � <br /> �, Sgnature o Cwner/Contractor/A�t_ onzed Agent Date <br />