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P�r�MIT APPLICATIG�� <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 /> ti -io --�y <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 3��� ��'a��—v,--..�—�� �v1 ���- � ( <br /> LEGA LOTNO. ' B�Q'K TRACT <br /> DESC. � <br /> OWNER AD�RE3: CITY2IP PHONE <br /> WcSiz.�2✓1 �tcfc ,¢io �2S W1A�a � �/• wA- <br /> TENANT NAME CONTACT'FOR PER� IT PHONE <br /> �v�.� ih'�'��s�,� �f�r� �s y Y�Y3"_ . <br /> CONTRACTORTET (Xv+n 4� �v�� �o�S=� �p3 y� �� ,v�TMma PHCNE � <br /> .� <br /> CONTR.LICENSE# J.�TPL= OIISCT i�}�7�r /y-Sv���/G CN,/� ,�'O - �/3� - ��ic <br /> USE OF BUILDING HEAT SOURCE I�;ONTRACT PRICE OF WORK <br /> c�� <br /> _ElecMc ,�Gas_Other GpU <br /> WORKDESCRIPTION 1rs��r�� � ys ��/� c �-v (>�1� r h«-'T�`"� <br /> .�,as��</ vzrf�lo�ovy� /'��r�-�' <br /> PLUMBING MECHANICAL <br /> NO. I TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXNRE OR ITEM <br /> � <br /> Toilet A/C–air handling unils <br /> Bathtub Forced air systems <br /> Lavatory(wasli basin) G�s piping <br /> Shower W ater heater <br /> Kitchen sink a, disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Laundry tray _ Range hood <br /> Sink(servicelbadmop/etc.) _ Exhaust fan <br /> Backflow prevenier Heat pump <br /> ' Unnal � Unit heater <br /> i _ Drinking Fountain _ Boiler <br /> Floor drain _ Refrigeration � <br /> � Grease trap _ Woodstove <br /> Roof drains Other <br /> Other <br /> — — i� <br /> I CITY OF EVERETT LOCAL SAlES SAX COOE IS 3105 I <br /> 'i I herehy ceritity that I have read and examined this application and know ihe same to be true and wrrect. All provisions of laws and �I <br /> ordinaces governing this type of work will be complied with whelher specified herein or not.The granting of a permit does not presume , <br /> � to give authonry to violate or cancel lhe provision of any other state or local law regulating construction or the performance of I <br /> i consWction.T at I am authorized by the owner of this property to peAorm the work for which application is made and I comply with the <br /> I, State Contra� rs La .1 7 RCW and 296.200 WAC. <br /> ..�;�c /� l/ /t�i D <br /> S' nature of OwneriContractor/Authonzetl Agent Date <br /> �� I <br />