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� PtRMIT APPLICATIGN � <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 ADORESS PARCEL TAX I.D.# PERMIT# <br /> 7 /�/.(a� SE , o 0 00o CcsSa�-o�-� `P <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CIN21P PHONE �3? <br /> ,��u+� � ((��i r�i t �Gr�n--�, (o l �S'µS f S[v F✓�•� 9 fr2o? <br /> TENANiNAME CONTACTFORPERMIT PHONE <br /> (,/c�c�� /l,v�w, S'L�a.v� +�Zf�- �4S-z k33 <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# � <br /> C /nJ�'f_� <br /> USE OF BUILDING HEAT SOIJRCE I CONTRACT PRICE OP WORK <br /> S�K— _Electric ✓Gas_Other <br /> WORK DESCRIPTION -/ -Q / �� y� I , �D/ <br /> d�SI,:D�� 'rC/�N � F-1el-� � '//G�ORlI <br /> �L bt <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet "' A/�—air handling units <br /> Bathtub �.�� Z Forced air systems <br /> Lavatory(wash basin) �rj Gas piping <br /> � Shower i �� � � Waterheater //// ' <br /> _�_ Kitchen sink&disposal Gas fireplace <br /> _1___ Dishwasher Gas range <br /> _� Glothes washer � Cbthes dryer <br /> Laundry tray � Range hood ', <br /> � Sink(service/badmop/etc.) �_ Exhaustfan J/�� ��. <br /> _ Backflow preventer _ Heat pump '�i <br /> Unnal � Unit heater �� <br /> Dnnking Pountain Boiter � <br /> Floor drain � Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> qTV OF EVERETT LOCAL SALES SA%CODE IS]105 <br /> I hereby cerilify that t have read and examined this applicatlon and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing thi;type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authonty to violate or cancel the provision of any other state or local law regulating construction or the peAormance 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 18.27R,�W nd 296200'NAC. <br /> i��G/ i�/r�---- /p�27�0� —� <br /> Si nature o Owner/ContractodAuthonzed Agent i Da�� �� <br />