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PtRMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 32C0 CEDAR STREET, EVERET I, WA 98201 <br /> 425-257-88'0— FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FRCM 8 AM TO 4 PM � Z �'��Q,6 <br /> SITE A�DRESS PARCEL TAX I.D.# PERMIT ll <br /> j 5 C!� �i-a���c,��r • Mc�ci� ,��1 <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYlZIP PHONE <br /> ;c,�t 5</i,� ✓'i' ���?_ 77l !`"�'rr� � �/��'�' J 'S��S- 2�-Y- �lyo� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �<<,;-, �' I �r l��/, f�,% �o���- z��� �z � <br /> CONTRACTOR ADDRESS CIlYIZIP PHONE <br /> Eyl:.Qti�.�i:• �;�� y ��i�' �� l' / i-':!"�Y e �-1+'[ %. �r1� � Z �. -�_ � <br /> � o � )- } � /,I/ <br /> CONTR.LICC-NSE# I S--�� I � <br /> F-yL-gn�ss c���z ��z � <br /> USE OF BUILOING HEAT SOURCE CONTRACT PRICE OF WORK ' <br /> I <br /> . l�` , ��.� i <br /> ��^������ �.;-�f�i� _Electric LC Gas_Other / 7_ <br /> WORK DESCRIPTION <br /> � <br /> ,�jP,ro'�'� C��C''I7ci'•� �irna'<c �p G- lG>/� -4i�)7cs' j <br /> PLUMBING MECHANICAL <br /> N0. TYPC-OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handling units <br /> Bathtub Forced air systems <br /> Lavalory(waeh basin) Gas piping <br /> Shower Water healer <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clolhes dryer <br /> Waler healer Range hood <br /> Sink(service/badmop/etcJ Exhausl fan <br /> Backflow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fowitain _ �oiler <br /> Floor drain Re(riyerelion <br /> Grease trap Woodslove <br /> Roof drains �� Other rG�. %� �•r�)�`- PS <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify thal I have read and examined lhis applicalion and kno�v the same to be true and correct. All provisions of laws and <br /> ordinaces goveming lhis type of work wi�l be complied with whether speci(ied herein or noL The granting of a permit does nol presume <br /> to give authority to violate or cancel Ihe provision of any olher slate or local law regulating construction or lhe performance of <br /> construction.That 1 am authorized by lhe owner of this property lo periorm the work for which application is made and i compl;•wah the <br /> State Conlraclols Law 18.27 RCW and 296.200 WAC. <br /> / ��!,. <br /> �ii` ! � (. � ��- 7��y� <br /> ,'-'"j <br /> Y <br /> SignaWre of OwnedConlraclor/Authorized Agent Date <br /> J <br />