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PE�.MIT APPLICATIOh <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 AGCEPTED�ROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT N <br /> — � . `_ � ;,, �._ c�s� � -�aD <br /> L �1i _.) <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRE33 CITY2IP PHONE <br /> �,� i <br /> . �l� � '1-� / lr.. l( tr� . ��'1 /� �1i�n•; .�i �i�;ll��f <br /> TENANT NAME CONTACi FOR PERMIT PHONE <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> '� t . r. �. ).C��ILL G- � <br /> Pnu. {ir'S � e,�,� I. ,.��icr. ! ( ` �> �, t�rY 1'�r3 S��iAa, .,.. � > 7, <br /> CON .LICENSE M <br /> USE OF BUILDING HEAT SOURCE CONTRAGT PRICE OF WORK <br /> ! J ��,� - ��,J �,� <br /> �-/k.��,�� _Electric _Gas_Other '�� _ — <br /> WORK DESCRIPTION <br /> n ' . /,`�� �t .'( )��•f � � ��C��� !/ �L �c It/h�h 'i• i 1 ��� 7C' �'ll.i�..� <br /> � �,i.'�l '!'. l � I' <br /> PLUMBING MECHANICAL <br /> N0. � TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> To�let !UC–air handling units <br /> Batl,tub Forced air syslems <br /> Lavatcry(wash basin) _ Gas pipinp � <br /> Shower Water heator <br /> _ Kitchen snk 8 disposal Gas fireplace � <br /> Dishwasher _ 3as range <br /> Clothes washor C!othas dryer <br /> Laundry lray Rango hood <br /> Sink(service/barl�hop/nlc.) Exhausl fan <br /> _ BackOow preventer Heat pump <br /> Urinal Unit healer <br /> _ Drinking Fountain Boller <br /> Floor drain Refrigeralion <br /> Groase trap Woodslove <br /> Roof drains Olher <br /> Other <br /> CITY�F EVEREI7 LOCAL SALES TAX CODE IS 3705 <br /> I heroby coritify lhat i have read and uxamined Ihis application and know the same lo be true and corcecL All provisions of laws and <br /> ordinaces goveming this lypo of work will ba complied with whelher speclliod herein or not.Thn granting of a permit does nol presume <br /> to givc�authonty to�iolalo or cancol lhe pmvision of any other stale or locat law regulaNng construcllon or lhe peAortnance of <br /> construclion. Th�t I am authonzed by lhr owner ol this property to periorm lhe work for which applicalion Is made end I wmply wilh lhe <br /> Slale Conlraclo�s Law 18.27�s,W and 29i�.200 WAC. <br /> ,/, , � Z . ,/l, �r•��,� /<<.�/�'�/r'J <br /> Signature OwnerlContractor/Authorized �ent ate T— <br /> i <br />