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PtRMIT APPLICATI(�N <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 <br /> SITE ADDRESS � (�— � � PARCEL TAX I.D.# P MIT p <br /> �-_,��;� ��� � �,�;��,, � ���� 0 -ZZ <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION p <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> (�;o� i r�c:r <br /> TENANTNAME `CONTACTFORPER PNONE <br /> �✓C�EI �I( I L.IiO�Jr �U ' >ILr/ �(�//2$Ic. ! y'j•��� IS'i�� - i-�%� <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> ��TH� �;,�i �sN r/✓ � JST��t=S <br /> CONTR.LICENSE# <br /> iY'tFtc_ �=, �i 9FF��v <br /> USE OF BUILDIyG I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ��' F�� / °'f'� ' < <` I _Eloclnc _Gas_Olhor �.� s <:)C� ODO <br /> WORK DESCRIPTION <br /> j-�-Vn,�� CT�� �_M(., (. �i� iJ(<F Fr�IL. �/L/}N�. S � f/�� C.K��2�c�t. i�ODIt; <br /> �'�r/=i c.(L: / r• p /} /•' ,/'r�> ✓ (��%:"1 ,?�,90�^� � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-alr handling units <br /> Balhtub Forced air systems <br /> Lavatory(wash l�asin) Gas piping <br /> Showor Water healer <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clolhos washer Clothes dryer <br /> Water heater Ran�e hood <br /> Sink(servicePoadmop/elc.) Exhaust fan <br /> Back(low proven�er Hea�pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Flocr drain Refrigeration <br /> Greaso trap Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 3705 <br /> I hereby ceriti(y lhal I have road and examined this application and know Ihe samo lo be truo and cortecl. All provislons of laws and <br /> ordinacos governinc�this typo of work will be complied with whether specifiod herein or not.TYe granting of a pertnit does not presume <br /> to giva authority to violato or cancel the provision o(any other state or local law regulaling conslrucUon or lhe performance of <br /> construclion.Thal I am authorizod by the ownor of this property lo peAorm the work for which applicaUon is made and I comply with lhe <br /> State Conlractors Law iB.27 RCW and 296.200 WAC. . <br /> i <br /> :��_ n:-, ;-, ..�' �.�• ;� �( � � ��, .1,� _' <br /> SignaWre of OwnedContractor/Aulhorized Agenl Date �IZ <br />