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��,_��,� 1;�.� ;,� �,I <br />P�MIT APPLICATI� <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STRE�ET, EVERETT, WA 98201 <br />425-257-8810 — FAX 425-257-8857 — www.everettwa.org <br />APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br />SITE ADDRESS PARCEL TAX I.D. # PERMIT # <br />, <br />�-`1��i �5 c�kes �l� ���� � i� �.�-��iU'� �Uc� ' , - <br />LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION # <br />DESC. �. �� �- � �n P `�`1 r - �-.' G' � v-z ;- Z �� 1 1 �T � � � 9 <- I� ��' �1 y <br />OWNER ADDRESS CITY/ZIP PHONE <br />�S , _ �t <br />���, 'iC�.� _����'� �`��`� ��a.��� /��/�� ���/, ��. ����,� 1����_�7ra,�;�)2 <br />TENANT NAME CONTACT FOR PERMIT PHONE �-1,-� �_7'ZO _�� � L <br />� 1 <br />I � � �, � _ �; n^' � � � ��� E-MAIL�'"c�r.,.�l . �,f1�2�M,;!"�,t <br />CONTRACTOR W,� �(� 1 ADDRESS CITYIZIP PHONE <br />$I �: ��IQfr+��r��r� <br />CONTR. LICENSE # <br />r /f'�T��' !-� % G %�/ �'Z <br />USE OF BUILDING ,+J��J-� HEAT SOURCE CONTRACT PRICE OF WORK <br />�'�`r`^`U I���'r''2 �J�Qr��"� _Electric _Gas_Other £✓� 2 �r"� <br />,�C7� CJc� C C/� % <br />WORK DESCRIPTION <br />�. -��, � <br />u n� � �', �h -e � . <br />� <br />S i,�. , I d, 'i n� A- j o. c- �� r� �, ���-h «. r-, o�{�� e � bo v� �-� v.,� �-E I� v- '�F - <br />�a''c���� w' ►� �, I�n h.��.v e c� 1a�.�.��.n�' he l��w �- f-. �- t' ��',fJ l o-e. <br />PLUMBING I MECHANICAL <br />NO. � TYPE OF FIXTURE OR ITEM � NO. I 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 />Water heater <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 />Exhaust fan <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 />-� <br />� <br />I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br />ordinances governing this type of work will be complied with whether 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 regulating 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 Contrac ors Law 18.2 �F�£W and 296.200 WAC. <br />� � � <br />� i%'�sY��-c�v� _/�-:.��,Q.r� �' L — � C <br />gnature of Owner/Contractor/Authorized Agent <br />uate <br />O �"� I <br />