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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 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 / Z � ��`�� <br /> SITE ADDRESS , ,. PARCEL TA%I.D.M PERMIT N <br /> Si�; i��,'t"C�; ; ���. /�' � ei � � � =�oc� l��-�G�( <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC <br /> DMflNF 1] /Ci <br /> ONMER — - auuntao ..��..�.. . .._..'_!. ,. .. �� . . _ .. <br /> DL (�) ` ` / 11.�/j �if 2Z 3 <br /> l� � �� ', : �P�rn �'. � yC � il�nl� f /�,� ,� � , Ql /iwy7D/a; <br /> TENANTNAME �/� CONTACTFORPERMIT PHONE <br /> �N �a / " IlA`-"y'''��"""/-1�'''-�♦��' 1 IIZZ�� I L.L ' �-4w1� / ` � ' ll !'� / 7 � <br /> CONT CTOR ' . "' ,�� ADORESS / CITY2IP PHONE ,,C(. <br /> ���C ��-,� _.�(.A. ELYCt[�i_ C' C � (K�tw.�, I I �Clc <br /> �� �z �� cc�,y ,�� ,.,,.� , y �; � 3`��5 <br /> CONTR.UCENSE/ <br /> PA c � (�►v �t c ►c H <br /> USE OF BUILDING HEAT 30URCE CONTRACT PRICE OF WORK <br /> IC <br /> f� Eleclnc _Ges Other I��� <br /> , ,� �� �u <<-; - - <br /> WORK DESCRIPTION � ._ . <br /> ���,, ; ��� �� �act ►�c .. ,,,1 C�t<<titit � �� � �r .� � � �� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FII(TURE OR ITEM <br /> Toilel _ aC-airhandlingunits <br /> Bathtub _ Forced eir systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower ._ Water heater <br /> Kitchen sink 8 disposal _ Ges Greplace <br /> Dishwasher _ Gas range <br /> Clothes washer _ Clothes dryer <br /> Laundry tray _ Range hood <br /> Sink(servicelbarlmopletc) _ Exhaust lan <br /> Backllow preventer _ Heat pump <br /> Urinal _ Unll healer <br /> Dnnkmg Founlain _ Boiler <br /> i floordrain __ Refrigeration <br /> Grease Irep _ Woodstove <br /> Roof drains _ Other <br /> � _ Olher _ — <br /> f ITY OF EVERETT LOCAL SALES TA%CODE IS 1106 <br /> II hereby cerddy Ihat I have read end examined Ihls app6calion end know lhe same to be true and coved. All provisions of lews and <br /> � ordinaces govrrmng Ihis type of work vnll be wmplled with whether sp^.cified herem or not.The granting of a permit does not presume <br /> � to grve eulhority to violate or cancel the provision nl any other slate or local law regulating wnstrudion or the peAortnance ol <br /> � construct�on Thal I am authorized by ihe owner o1 this property to perlorm the work for which application is mede and I comply with ihe <br /> i Slate Contractors Law 18.27 RCW antl 296 I200 WAC <br /> n-� �' XI lc. Z) ���'" lZ !�3 L �✓ <br /> Sig � ur o�wn onlractor/Author¢ed Agent a ��L <br /> �-. . .. _—�------- .._----------- <br />