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� PE��MIT APPLICATIO�v <br /> � <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 &CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS ��f i�,( ' � (� ���� PARCEL TAX I.D. # PE�+IT# <br /> � ou��o �,�} I t�o�l Cc I ( '�// -lUn/> <br /> LEGAL LOT N�. BLO i TRA���1{^U I I"71 I <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE ✓ <br /> _L�4s <br /> �y �Jtirnlea��n��� i� �-��I��r ��3- ��'�� Q-ve. �ve.r��{- qS � � ,q�ti. <br /> TENANT NAME I CONTACT FOR PERMIT ' PNONE ' <br /> i .� �'j ' <br /> CONTRACTOR - , , ADORESS . � � CITY2IP PHONE � �$3 � / <br /> . f�/. _ . - r . . � . . ic�iJU1J/E; F':, ! �'.� i�:.� 'tt. � 4 0 <br /> ���u�� <br /> CONTR.LICENSE# � ' <br /> -�I ,��;..� � � , ,/-!• � , .� <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> �f ,/p��(' ��{71(��.Yl(;�� _Electric �as_Gther � '���) °`-�- <br /> WORK�ESCRIP710N . .�,-� "� � � _ ' .��. 2-_ .��. i ', �� !� -!-. �;,i., /r �.-;�- �?,�it�� ��i; �Y'A'�.(�/+ <br /> , . . . . :i� � . :� , ,� , _ <br /> � � ^ <br /> i� . , .. .) G. . , .`J ,-_ . // . '�'i.�Ic'��. <br /> I <br /> PLUMBING MECHANICAL <br /> N0. I TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> i�C Toilet A/C-air handling units <br /> Bathtub'�)��i�,,, �,.,i�V,�. _ Forcedairsystems <br /> � avator�(wash basin) Gas piping <br /> Shower Water heator <br /> Kitchen sink 8 disposal Gas fireplace <br /> _ Dishwasher Gas range <br /> _ Clothes washer Clothes dryer <br /> _ Laundry Iray Range hood <br /> Sink (service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> _ Floor drain R�frigeration <br /> Grease trap Woodstove <br /> Roof drains Othar <br /> Other — <br /> I 1 —I — _ <br />, i <br /> iCITY OF EVERErT LOCAL SALES TAX CODE IS J10S <br /> I hereby ceritity that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> I ordinaces goveming this typo of work will be complied with whether specifed herein or not. The granting of a permit does not presume <br /> lo give authority to violate or cancel the provision o(any olher state or local law regulaling construction or the performance of <br /> construction. That I am authonzed by the owner o(lhis property to perform the work for which application is made and I comply with the � <br /> State Conlractors Law 10.'7 RCW and 29n.200 WAC. <br /> ' . ...�;.y , <br /> :%i'� ; i� v�'�� ,�% '�-�3� <br /> Si ature of OwnenContractonAuthonzed Agent Dale ��` <br />