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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVI�ES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> ! 425-257-8810-FAX A25-257-8857 -www.everettwa.org <br /> �� i APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> � — I PERMIT A <br /> SITE ADDRESS I PARCEL TAX I.D.M Ji�C � ! ; U�� ('I _ <br /> -3 _CCS -- � /( ()� v <br /> LEGAL LOT NOi ��_ BLOCK TRACT <br /> DESC �� �;�1� <br /> OWNER C ,.7 <br /> ADDRESS ���p PHONE <br /> 1\n �� �1�X J7��� /'(/�S�/��)7 �P���f� � N �Q���/ <br /> ���1� �e PHONE <br /> TENANT NAME � CONTA�I �T F�R PERMIT <br /> � ^ �y�, � � ��� �r��.��P r �S 3 - ��� -������� _ <br /> --�v---�7��� arnnv r4oNe <br /> CONTRACTOR �' ' // AODRE S i� 3 f�57-BS�I' �'' <br /> �C_LO �ihYP�-.e'.� �'�kvNS �S�' NGrit�i–aI !�/P �ti�(�Lk� � J' <br /> CONTR.LICENSE N <br /> ��_: �� `171/�Y1- -- <br /> USE OF BUILDING <br /> HEAT SOURCE CONTRACT PRICE OF WORK <br /> ' f_lectnc ___Gas_Other 3r/CL��(� _ <br /> CNe.� � S�_�e ------- <br /> WORK DESCRIPTION <br /> � �- ,�11:� � �'l�-��� `� <br /> . ,l nn�i .� - Jr C. <br /> �� 1M1�CHANICAL <br /> PLUMBING <br /> NO. TYPE OF FIIfTURE OR�TEM <br /> NO. TVPE OF FIXNRE OR ITEM <br /> — AIC-eir handling umts <br /> Tollet Forced air systeme <br /> Bathtub — cis piping <br /> � Lavatory(wash basn) -- V�aler heater <br /> _ Shower Gas tireplace <br /> _ Kitchen sink S disposal — Gas range <br /> Oishwasher Clothes dryer <br /> Clothes washer Range hood <br /> Laundry trey Exhausl fan <br /> � � Sink(serncelbarlmop�e�c ) _ Heal pump <br /> �ackflow preventer UNt heater <br /> Unnal — goiler <br /> Dnnking Fountain — Reingeralion <br /> Floor drain — yyQodstove <br /> _ Grease trap — p��,er___,�— <br /> Rooldrains —���� <br /> �_ Olher_ "—"— _ <br /> - -- -- -- --- — - � - - -.. <br /> - _ _ _ <br /> --- --- <br /> CITV Of[VERETT LOCAL SALES TA%CODE IS 7706 <br /> I hereby ceritdy thal I have read and ezammed this apphcahon and know the same to be Irue and correct All provisions ol la'Ns and <br /> ordinaces govermng this type of work wdl be complied wdh whether speafied herein or not The granting ol a permit does not presume <br /> to give authonty to violate or cancel the provision of any other state or local law regulatmg construMion or the pertormance of <br /> conslruction That I am authonzed by the owner ol this property to Perlorm the work for which applicahon is made and I comply with the <br /> State Contractors Law 78 27 RCW and '296200 WAC <br /> SignaWre ol O.vnedContractodAuthonzed Agent Date <br />