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— – — —�- <br /> P�RMIT APPLICATI�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> I 3200 CEDAR 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 I� `a J `'O 6 <br /> PARCEL TAX I.D.N PEAMIT N <br /> SITE ADDRESS ,i <br /> S I � �'�.; �' �' I i ' _�,/l ) – ,� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRE53 GITY2IP PHONE <br /> l� kl � �i��'�{ Wl�:� ;f' (,l,i.c hGl �ir�lrr���� �tvti Gl�aCii16���. , W� ��- .��� � <br /> TENANT NAME I CONTACT FOR PERMIT � PHONE <br /> I '/11 'il ,L��IK �'rf � } � � i ICr. � � ti C� < < c��1 �� L =?'�I> - R�� � <br /> CONTRACTOR � _ �! ADDRESS CITY2IP . PHONE <br /> I ( ( 1 f ��IINC ( C (� i� , I LC 17>7 1 [ vt � C���;��< < {,)i � i.� ("' ( l�( t��� ,��C C , LvY � <br /> coHrR.i.iceHse r 1'C t- l [ T� L�5 `� k Cv 4 7 S- �� �)�i 5 4 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ,�� i�� [ �; `_Eloctric _Gas_Olher � �l�, L� � �. <br /> WORK DESCRIPTION <br /> j <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> B�thtub Forced air r,ystems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water healer <br /> Kitchen sink 8 disposal Ges fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clolhes dryer <br /> Laundry tray _ Range hood <br /> Sink(servlce/barfmopletc.� _ Exhaust lan <br /> Backflow preventer _ Hea�pump <br /> Unnal Unil heater <br /> _ Dnnking Fountain Boiler <br /> Floor drain _ Reirigeralion <br /> Grease trap _ Woodstove <br /> Roof drams Other <br /> O�her <br /> , CITY OF EVERETT LOCAL SALES TAX CODE IS J10S <br /> I, I hereby ceritdy that I have read and examined this application and know Ihe same to be Irua and coned. All provisiona of laws end <br /> ordinaces govemmg thls lype of work will be complied with whether specifiod herein or not.The granting al a permit does nol presume <br /> �� to give authorlty to vlolate or cancel the provision oi any other state or locnl law regulating conslruction or the peAormance oi <br /> � construction. That I am authorized by the owner al this property to perform the work for whidi applicahon is made end I comply with the <br /> I�� State Contractors Law 18 27 RCW and 296.200 WAC. <br /> i i <br /> '� J !� , �:. ��� i/,.j,� /C � 1C G � <br /> �I Signature�o wnerConirador/AuthonzedAgent Date �/ <br /> IL <br /> � ------- — --- -- <br />