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P�RMIT APPLICATIC�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDP.R STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE A�DRESS PARCEL TAX I.D.# PERMIT# <br /> 3625 3r�w -#'D . I /�,Z�i/� '.� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER qDORESS Cf1Y/ZIP PHONE <br /> U-aM�r 36� ���n�N�s <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> w����+�� rz-���,�ki I F�ti: ��_p Sa ,�oG -3�U - 36 �� _ <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> �` 9���3 <br /> CONiR.IICEf75E# ,c-�t„j SCL��1C��J C 16� �1{-�� �1 A� ���-�Y �-°6 , 3 f o� <br /> (.. <br /> USE OF BUILDING HEAT SOURCE CONTRA T PRICE OF WORK <br /> ��r��p�y�T _e���c��� �Gas_Olher IZfVT� <br /> i a�ric,� <br /> WORK DESCRIPTION <br /> I��s�a-��� t.��- wA-?2-2 d{�-ar-t��', (;�,nc.� ( N c o� f,� . �G� t H�a �7 <br /> PLUMBINC+ MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXNRE OR ITEM <br /> _ Toilet A/C—air handling units <br /> _ 6athtub Forced air systems <br /> _ Lavatory(wash basin) Gas piping <br /> _ Shower J_ Water heater <br /> _ Kilchen sink 8 disposal Gas fireplace <br /> _ Cishwasher Gas range <br /> _ Clothes washer Clothes dryer <br /> _ Laundry trey � Range hood <br /> Sink(service/bar/mop/elc.) Exhaust fan <br /> _ BackP.ow preventer Heat pump <br /> Unnal Unil heater <br /> Drinking Fountain Boiler <br /> _ fluorCrain _L Refrigeration <br /> _ Grease trap Woodstove <br /> Roof drains �_ Other rY��'{a��, <br /> � Cther <br /> I <br /> i <br /> � CITY OF EVERETT LOCAI SALES 7AX CODE IS�105 <br /> � I hereby ceritify that I have read and examined this application and know the same to he lrue and correct. All provisions of laws and <br /> I ordinaces governing this type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> ito give authonty to violate or cancel the provision of any other state or local law regulating consWction or the performance of <br /> construction. Thai I am authorized by the owner of this property to perform the work tor which application is made and I comply with the <br /> ISlat ntrac/{tt��rs Law 18`.2j RCW and 29�.200 WAC. <br /> _���'a=——//. /� �6 - 3/ — c`� <br /> I Si ature of CwnenCOntractor/Authonzed Agent Date � � <br /> d <br /> I <br />