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i <br /> 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 - DEB!T 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# P�RMIT# <br /> Z lo I'-S CC�t� �'S /}�3�c Gb :1 lo� /3 U•� S CJ o �o N.01- ��{ <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PNONE l� `Y3_Ot�b9 <br /> lJ�170 TR.�/� �L� 6�Z 5 YI' S�f. NN1`I �dZ �iLIG-LAJa �n�. �lT(0j3 <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> �Nre-r�.io�.- F� x �}e�;F fI��1 ,�so�.,. �12s 3�1� s� l � <br /> CONTRACTOR �h �A�DDRES \ �a Q�ITY21P PHONE <br /> �I D �wlSc7rJ �Il1S � /"��-�l�N � 1 Ll �L�� (�fi.?'.J �1�:�{�'ti1 W <br /> CONTR.LICENSE f! Z�y �`"� W� �'� � <br /> ��T.{� A-LLG= L70`-IK�I �t St'Lti' `iL)'�'-16 �:S'! � <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��-��rr�L (p(�={C�^ �Eiectric _Gas_Other � ���.� <br /> i <br /> WORK DESCRIPTION <br /> �=,{Lit-L'� �Co�+STtc�C. C� /L � �✓�i <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet AIC-air handling unils <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Waler heater <br /> Kitchen sink 8 disposal _ Gas fireptace <br /> Dishwasher Gasrange <br /> Clothes washer Clolhes dryer <br /> Laundry tray _ Range hood <br /> Sink(service/badmop/etc.) _ Exhausl fan <br /> Backflow prevenler _ Heat pump <br /> Unnal Unit heater <br /> Drinking Fountain _ Boiler <br /> ! Floordrain Refrigeralion <br /> Grease trap _ Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 9f 05 <br /> I hereby ceritify that I have read and examined thfs application and know the same to be We and correcL All provisions of laws and <br /> ordinaces governing lhis type of work will be complied with whether specified herein or not.The granting of a pertnit does not presume <br /> to give aulhority to violate or cancel lhe provision of any olher state or local law regulating construclion or the periormance of <br /> construction.That I am authorized by lhe owner of this property lo pertorm the work for which application is made and I comply with lhe <br /> Stale Contractors Law 18.27 CW nd 296.200 WAC. <br /> (�c.. 7— � 6 '� ^ � <br /> Si natur f Con cloqAuthorized Agenl Dale �/ <br /> L <br /> 1 <br />