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-- -- -� <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES ' <br /> 3200 CEDAR STREET, EVERETT, WA 982�� <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> � APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS !-aRCEL TAX I.D.M <br /> PERMIT 8 � <br /> 3 c inCS(iU)/�,190 �C�(� oG� o v 0 <br /> �CGs�dA <br /> LEGAL LOTQ,NO BLOCK TRACT <br /> OESC � � <br /> OWNER <br /> -- --- ADDRESS CITYIZIP PHONE <br /> ��^ /� � �/� r C <br /> WP I�C 1 fI�'✓1I�C� � PHONE <br /> TEN/A�NT NAME CONTACT FOR PERMIT <br /> /'�/�����/ /'/,^ V,nv �PiIP✓1 �J�f�P_.1�P�I�P ( .Z S 3 ��/ "�'/`/`! <br /> '�.LL�'=`�—��—{a-�-�-7� CITYIZIP PHONE <br /> CONTRACTORJ ' / ADDRESS / / ,n .e ? 3 j,%7_�S�I- ��' <br /> �C_L�� ��"�YP�����klv�C � � N GP�tt!-a r��ri �fl��, � �' <br /> CONTR.LICENSE N <br /> /�C�U�S/ �971!'u� CONTRACT PRICE OF WORK <br /> USE OF BUILDING HEAT SOURCE <br /> I �^ (�� � f:lectric Gas Othe� a 3r/CCb�� <br /> CN--- Co�iw )�vv- � `-1-�--- <br /> WORK DESCRIPTION <br /> � � C <br /> ��' � ��� � <br /> , ,��,_�i ,.� - Jr � <br /> �' ---- MECHANICAL <br /> PLUMBING <br /> NO. TYPE OF FIXTURE OR ITEM <br /> NO. TYPE OF FIXTURE OR ITEM <br /> ---- — A/C-air handBng unfls <br /> ToAe� Forced air systems <br /> � Bathtub _ Gas piping <br /> Lavalory(wash basin) Waler hea�er <br /> Showcr Gas lheplace <br /> Kdchen sink 8 disposal — Gas range <br /> pishwasher — Ciothes dryer <br /> CloUies washer — R�nge hood <br /> Laundry tray Exhausl lan <br /> � � Smk(service/barlrcoplelc � _ Heat pump <br /> BackOow prevenler Unil healer <br /> Urmal Boiler <br /> Dnnking Fountain — Reingeration <br /> Roor Arain Woodstove <br /> Grease trap ' p(her_�_ <br /> Roof drams j� — <br /> � Other �� — <br /> I - - - --- -- ._ __ __. . _. .. <br /> _ _ _ ._------ ---- <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7106 <br /> I hereby cenUfy thal I have read and ezamined lhis applicalion and know the same to be true and correM All provisinns of laws and <br /> ordinaces governmg lhis type ol work wdl be comphed wdh whether specdied herein or not 1 he granLng of a permi�does not presume <br /> to gwe authonty to violate or cancel the provision ol any other state or local law regulating cons�rucUon or the perlormance of <br /> consiructwn Thal I am au�honzed by the owner of this property lo perlorm ihe work tor which appllcalion is made and I compty with ihe <br /> State Contractors Law 18 27 RCW and 296200 WAC <br /> ISignature ol OwnedContrector/Authonzed Agen� Dete <br />