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� <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www.everettwa.org I' ` 3 � <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS � PARCEL TAX I.D.# P RMIT# <br /> I -� �� � w�. 7 13 ���3 `yq _uo.� c� c� �.1 // - Oo/ <br /> IEGAL LOTNO. BLOCK TRACT ' r <br /> DESC. . •�1----�'�c�.i�� <br /> OWNER --��r�� v <br /> I ' ADURCSS CITYRIP PHONE <br /> n�� (7� ��l � <br /> !/ L- ����✓ �'�S� -`>t,�.'r tMA Su�rl�� Cvl� Q j j7L <br /> � TENANT NAME CONTACT FOR PERMIT � PHQNE <br /> 7 � <br /> �d ��/ .��t <<-d' 2 � I vvl wf �+�'a�? G1� � � 1 ' /2v�� <br /> CO TRACTOR ADDRE55 �N�� qTYZP PHONE (.�Zf <br /> � �r y c �� � i � l�i:-f� ,�,� r,� <br /> "O TR.LICE�E p � � � S � � (� p � Z I.2 U[/ <br /> �/</i�� �� �� () � � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OFyVORK <br /> � .v CJ <br /> � (�`�. ( L _Electric _Gas_Other ��� p Ui J• <br /> WORK DESCRIPTION ` <br /> / N s7� t L �-' �LG-�w i �a��� �.c�a �-G -�j'�Q,�1. <br /> PLUMBING MECHANICAL <br /> NO. IYpE OF FIXTURE OR ITEM NO, TYPE OF FIXTURE OR ITEM <br /> Toilet NC—air handling unils <br /> _ Bathtub Forced air systems <br /> __ Lavatory pvash basin) Gas piping <br /> _ Shower Water heater <br /> _ Kitchen sink 6 disposal Gas fireptace <br /> _ Oishwasher Gasrange <br /> __ Clothes washer C!othes dryer <br /> Laundry tray Range hood <br /> Sink(servicePoadmop/elc.) Exhaust fan <br /> _ 8ackflow preventer Heat pump <br /> _ Urinal Unit healer <br /> Drinking Founlain Boiler <br /> _ Floordrain Refrigeralion <br /> Grease irap Woodstove <br /> Roof drains � Olher <br /> 01her — <br /> CITY OF EVERETT LOCAL SALES'fAX CODE IS 3105 <br /> I hereby ceritity lhat 1 have read and examined Ihis application and know lhe same to be true and cortect. All provisions of laws and <br /> ordinac2s,oveming this type of work will 6e wmplied with whether specified herein or not.The granting of a pertnit does not presume <br /> to r,�ve authority to violate or cancel lhe�rovision of any other siate or local law regulating constrtiction or the perfortnance of <br /> cons tion.Thal I am aulhorized by lhe owner of this property to perform the work for which application is made and I comply with the <br /> Sta ontractor�Law 27 RCW and 296.200 WAC. <br /> %l'l ,��� �tti,t�1 30 0 <br /> Wre of OwnedContractor/Authonzed Agent ate I/� <br /> � <br />