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, <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICE�S <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425•257-8857-www.everettwa.org <br /> APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM S � �j I� ' OU/ <br /> SI7E ADORESS PARCEL TAX I.D.JI PERMIT# <br /> " zD .�� ' C�r••� Cl�_ G G�� Jt=7a � �5 <br /> LEGA LOTNO. BLOCK TRACTORSUBDIVISIONp <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> r-^ <br /> /2• y E a�t�en 1R?.1�y z SCX�7 s�v�i'> �.�_ 9eizi/ zo6 �1�,- •tl•�f/ <br /> TENA TNAME / CONTACTPORPERIdIT PHONE zig-id,'�—Ojf.z <br /> �//�,f g;,/ �Is I /''% �b�i'�'"'s�r'r`'K�-[��, . N�7� <br /> � $$ V/ZIP PHONE <br /> Gvf�C,. .�....�=se �yt�� s�f i��v�E T�� �- ?S9-S3S-�7f.Z <br /> CON7R.LICENSE M �5�� <br /> /'uL.81=5`�18HMG1 C�p S�.�v <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electdc Gas Other ��5�� � <br /> G�•,e�H,-t��.� �vNr�s�• — — — <br /> WORK DESCRIPTION ' �K L � � P_/�� <br /> � % S�/1 /�y T w< <br /> ,�t3�j� lr«J � <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FlXTURE OR ITEM N0. TVPE OF FI%TURE OR ITEtd <br /> Toile� A/C—air handling unils <br /> BatMub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kilchen sink&disposal Gas(ireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop,�etc.) Exhausl fan <br /> _ Backflow preventer Heat pump <br /> Urinal Unit healer <br /> _ Drinking Fountain Boiler <br /> Floor drain Relrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS 3f05 <br /> I hereby ceritily Ihal 1 have read and ezamined ihis application and know the same to be true and correct. All provisions uf laws and <br /> ordinaces goveming this type of work wili be complied with whether specilied herein or noL The graniing of a permit does not presume <br /> to give aulhority to violate or cancel ihe provision of any olher state or local law regulating consiruction or ihe pedormance ot <br /> construction.That I am authorized by the owner of ihis propetly to pedorm the work for which application is made and I comply with the <br /> Staie Contractors L 827 RCW anC 29620 AC. <br /> � � ) <br /> ✓' /lfi � //� �.l�f Gl�.z�Jj �L�'�' <br /> Signature of wnedContractor/Authonzed Agent Date <br /> �Z <br />