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P�RMIT APPLICATI(�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425•257-8810- FAX 425-257-8857-wv�nv.everettwa.org <br /> APPLICATIONS AP.E ACCEPTED FROM 8 AM TO 4 PM (� � (z �7 <br /> SITE ADDRESS • PARCEL TAX I.D.il PE� �oG, <br /> LZ `7 � �/U•�C �Gi.�<< t <br /> LEGA LOTNO. BLOC TRACT <br /> DESC. <br /> OWNER ADORESS /CITY2IP�y�i� Z�/NE <br /> �i� siii-���rrr �{'• � J�t�- � Z 3 � �i'a::�i ,/ �;-. v�ik (/ �zs- 75'L - �/�:� <br /> TENANT NAME I `CONTACT FOR PERMIT � PHONE <br /> I����c:.;/s �� / vz•�- z3� � Tz � <br /> CONTRACTOR , ADDRESS CITY2IP PHONE <br /> � 1/�it ��i. _ jt�S '� �'r� 3��' ��� r��f�' '7�i` L-��.LTT �1L 'i- 1'.�%- l�l� <br /> CONTf�.'_ICENSE# <br /> �Y�.q,�ss�y z k� <br /> USE OF BUIIDING I HEAT SOURCE ONTRACT PRICE OF WORK <br /> -t� <br /> (�� U j q 1 r� � �%.-/ �Eleclric _Gas_Olhet ���1� <br /> WORK DESCRIPTION <br /> � ° '� <br /> �c./ � �;,; y�,cr,.Il cJ <br /> � / " ` / <br /> PLUM6ING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toiir,( !dC-air handling units <br /> Balhlub � Forced air syslems <br /> Lavatory(wash basin) Gas piping <br /> Shower Wa,er heater <br /> Kilchen sink 8 disposal Gas fireplace <br /> Dishwasher Gasranc�e <br /> Cblhes washer Clothes dryer <br /> Water heater Range hood <br /> _ Sink(service/badmop/ela) Exhausl fan <br /> Bac4flow prevenler Z Heal pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstovo <br /> Roo(dralns Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I here6y cerilify that I havo read and examined this application and know lhe same to be true and correct. All provisions o(laws and <br /> ordinaces governinc� lhis typo of work will be comp�ied wilh whether specified herein or not.Tho granling ot a permil does not presumo <br /> lo give aulhorily to violate or cancel the provision of any o(her slalo or iocal law regulating conslruction or the peAortnance o( <br /> construction.That I am authorized by lh�owner of this property to per(orm the work for which application is made and I comply with the <br /> Stale Contraclors Law 18.27 RC6V�nd 2�36.200 WAC. <br /> /' / �i ✓` j�'' ry <br /> , � ` iz "-� � <br /> Signature ci Owner(Contractor/Aulhonzed Agent Date <br />