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I�ERMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-SB10 - FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM T04 PM S ��a �� <br /> SITE ADDRESS PARCEL TAX I.D.# P MIT# � <br /> -'�'i " j �� � '�5 �3 cr��G' ' OO � S� <br /> LEGAL LOTNO. BLOCK TRACT <br /> C°SC. /� <br /> OWNER ADDRESS 7 CITY2IP PMONE <br /> �/ � - � �l � �l� ��i `���, '/1�=3�7-jC7G <br /> �"d � 7 �i2/���tC �ti���as7n,,�.v � �/� � <br /> TENANT NAME CONTACT FOR�ERMIT PHONE <br /> �� <br /> �.� �e �� l,� Fr-/�/ �;����.��- y���- <br /> ., ADDRESS CITY2IP PHONE <br /> CONP'ACTOR C'/����(�/ JH"X u.c '!� v4 ., e Y/ �R3[7" y <br /> ��,� � qyi�f���e <br /> CONTR.LICENSE It �k I� � .I C�I �,� T�/( 1�l"� ���'�'� ���7� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � ¢c, <br /> r <br /> � � Eloclnc Gas Othor '� c� � <br /> � P� — — — <br /> WORKOESCRIPTION � � � ��,� %�G� ��^� �I/ ��/'�"��/ <br /> ii G, C �t'� / // <br /> � �''� `'`�-� ` i��c%iicC �t�/��/�� a��`„� �:.T�/rI ll <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIKTURE OR ITEM <br /> Toilol _ A/C-air handling unils <br /> Bathtub _ ForceA air systems <br /> Lavatory (wash basin) _ Gas piping <br /> Shower _ Wa�or healer <br /> Kitchen sink 8 disposal _ Gas(ireplace <br /> Dishwasher _ Gasrango <br /> Clothos washer __ Clothes dryer <br /> VVater hoa�or _ Rango hood <br /> Sink (servicolbadmop/etc.) _ Exhaust fan <br /> Oackilow proventer _ Heat pump <br /> Urinal _ Unil heater <br /> Drinkin� Founlain _ Doilcr <br /> Floor drain __ Re(ngora�ion <br /> Grease trap _ Woodslova <br /> Rool drains _ Othor <br /> O�hcr_ ____ — <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS �105 <br /> I hereby ceritily�hat I have road and ezamined Ihis application and know Ihe same to be true and correcl All provisions of laws and <br /> ordinaces govemin�lhis lype ol work will be complied with whelher specifiod horein or not.The granling ol a permit does nol presume <br /> lo givo authorily to violale or cancel lhe provision ol any other slate or local law reg�laling consWclion or the pedo�mance o� <br /> consiruction.That I am aulhorized by Ihe owner ol lhis property to perform lhe work lor which application is made and I comply with the <br /> Slate Con�rac�ors Law ti3.27 RCW and 296.200 WAC. <br /> / � j�J � /(- �/r'��.�-P Sj�/R���c <br /> Signaturc o� wnor'Contraclor/Authorized Agent Date <br />