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-- — /Z —a —� <br /> PLr�MIT APPLICATIG�J � <br /> CITY OF EVERETT PERMIT SF_RVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-q810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FRpM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITL AD�RESS PARCEL TAX I.D.# PERMIT p /� <br /> � , _ <br /> - (_ i '(.i' ; � 1��� __. I <br /> IEGA LOT N0. BLOCK TRACT �^ O� ' Z_� I <br /> DESC. I � � ` <br /> OWNER ADDRESS CITY2IP PHONE <br /> TENANT NAME CONTACT FOR PERMIT PNONE <br /> v �,In� -,, (�s��w�r���� 70� 37� 9�19s <br /> CONTRACTOR I 1 ,n`l'1 � ll�lu f� AO RESS ��.�'�'L-/�'1� 1,1L�QSCITYRIPj'��-�PHONEl��S ?5SIy�l`� <br /> rA m�'<I <br /> tv n 9 4<OSS <br /> GONTR.LICEN9E N ����l ��'i.�'�� i,�4�} ,j� <br /> IIISE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> I,f�� I�;,�/ _Electric �Gas__Other � zc;1 <br /> WORK DESCRIPTION q <br /> I����!<<ce �'�l �ti� c��', � � �ir��� C�'c�C�l,��z� `,}�.�1 .k K�i-l�i v� <br /> PLUMBING MECHANICAL <br /> NO. NPE UF FI%TURE OR I7EM NO. TYPE OF FI7CTURE OR ITEM <br /> Toilel A/C-air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower W ater hoater <br /> Kitchen sink 8 disposal Gas fireplace� <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryr.r <br /> LaunCry tray _ Range hood <br /> Sink(servicelbadmop/etc.) Exhaust fan <br /> _ BackOow preventer Heat pump I <br /> � Unnal Unit heate�� <br /> � _ Drinking Founlain Boiler I <br /> Floor drain Relrigeration <br /> Grease trap N:oods o��e <br /> = Roof drains — � Other� � ; `�'� <br /> Other _ �4d <br /> CIN OF f:VERETT LOCAL SALES TAX CODE IS St05 <br /> , ' hereby ceritify thal I have read and examined this applicalion and know tha same to be true and correcL All provisions of laws and <br /> ortlinaces govemmg Inis rype of work will be compliiad with whether specified herein or not.The grenling of a pe�mil does not presume I <br /> �o gfv&authonty t9vfb�e or cancel the provision of any other state or local law regulati�g consWctlon or the perfo�mance ot <br /> �:tlnstr c �" r�.ThAt I am Uhonzed by the owner of this property to perform the work fer which aFplication is made antl I comply with the � <br /> 'jtate�o t�acto�s Law/18.2 R and 296.z00 AC. <br /> � / ,/ � . ` C .. � : <br /> �, , f� <br /> Sig atu ofOwner, ont cen uthonzed tJ�nt ate <br /> � <br />