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PE�<MIT APPLICATIO�v <br /> CITY OF EVERETT PERMIT SERVICES $��a � <br /> 3200 CEDAP. STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-E857 -www.everettv.�a.org � p y b�'-d3{ . <br /> APPLICATIONS ARE ACCEPTED FRf�M 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED I <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# �I <br /> z� �� b �c�u.�C.��u� op43 �l3iut �'oo I <br /> LEGA LOTNO. BLOC2Kq TRACT/� ( ..(_ 1' f� <br /> DESC. Z�� �� � J 1 I' 1 ^- ` /� 1��� V( 1�� � <br /> OWNER ADDRESS CITY2IP PHONE <br /> (,J ��S� �'';�j'�CY- l (� o � I�i ��ccr , J:ve�t�-' y2s'-33`/ �b'.S3 <br /> TENANT NAME � I CONTACT FOR PERMIT PHONE <br /> 5 4�„+ -�� <br /> CONTRACTOR ('J�,J v�C (�� ADDRE55 CITY/ZIP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> S �— � �Electric _Gas_Other �( %��, <br /> ��. <br /> WORKDESCRIPTION {���'' fe - Wif2� � p�� ;a �� —pl�w. � ne�� ('e4r 5 4�JS1 <br /> f L 1 f <br /> �'Q /�k� f ;�. PG.� ✓�1 �.n.�T¢ � �er Plai'�-•r �„/r� �� S . <br /> I <br /> f� � � <br /> .._i-�.l�:-'I '(.( ._f �. ! r� /CC _ {.%�7`. '.� <br /> _ PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM � <br /> 'Z Toilet A/C-air handling unils <br /> I Bathtub Forced air systems <br /> 'y Lavatory(wash basin) Gas piping <br /> Shower = Water heater <br /> � Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> 1 C�othes washer _L Clothes dryer <br /> Laundry tray Range hood <br /> Sink (service/badmop/etcJ Z- Exhaustfan <br /> _ Backflow preventer Healpump <br /> Urinal � Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeretion <br /> _ Grease trap Woodstove <br /> I _ Roof drains _ Other I <br /> _ Other _ � <br /> C1TY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I <br /> I hereby ceritify that I have read and examined this applioetion and know the same ro be true an,�1 correct. All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whether specified herein or not.The g:anting of a permit does not presume <br /> to give authonty to violate or cancel the provision of any olher slate or local law regulating construc;�on or the performance of <br /> construction.That I am authorized by the owner of this property to perform ihe work for which applicacon is made ard I comply wilh the <br /> State Contra�tors w 1827 RCW�nd 296.200 WAC. <br /> ��� G�.f�v 8�30 �°`� <br /> ISignature of�Own�I ontractor�Authonzed Agent Date <br />