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J 1 l <br /> P�r2MlT APPLICATIG�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> :i200 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 - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS Z6 I�o C�i��E pARCEL TAX I.D.# PERMIT# <br /> � �T �✓y n�oSoS-o0 <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADORESS f� CIlY21P PHONE <br /> �(���2% /-2//�G-L (voz- > S� ` 7.�6 — �`"c3 - O�IS <br /> �- ki6zf«.✓o ��0 33 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> Ui�c�� CF-r—C�,es �'oa/ �/�.�/��. 3� o -79Y- 73a� <br /> CONTRACTOR / �� �/r�_�����CJ ADDRESS y�� �Sr CITY2IP PNONE <br /> <r i��r 3G o <br /> CONTR.LICENSE# k`�/r� S� �v u�o� <br /> G-SH��/¢7J1� 98Z7L 7 ��-73a�' <br /> 11SE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �Ejcls T/NF <br /> �� �/�/�, _Electric )cGas_Other � ���� v0 <br /> WORK DESCRIPTION �.. <br /> /�VST�� SPL� T /�� SYS i �n <br /> �NGLuD�•v� l�CJG i G/D� (� <br /> PLUMBING MECHANICAL <br /> ND. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet ,� A/C-air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas G�Ping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Cloihes dryer <br /> Laundry tray Range hood <br /> I Sink(service/bar/moplelc.) Exhaust fan <br /> Backflow preventer Hsat pump <br /> Unnal l:nit healer <br /> Drinking Fountain B�iler <br /> Floor drain Refrigeration <br /> _ Grease trap � Woodstove <br /> Roof drains � Other O�/7 C�� C�'=�n���yG' U'�' � <br /> Other <br /> _ —I <br /> CITY OF EVERETT LOCAL SALES SAX CODE IS 3105 <br /> I hereby cer"'" 'hat I have read and examined this applicatlon and know the same to be true and correct. All provisions of laws and <br /> ordinaces guverning this type of work will he complied with whether specified herein or not.The greniing of a permit does not presume <br /> to c�ive authonry to violate or cancel the prcvision of any other state or local law regulating construction or the pedormance of I <br /> construction.That I am aulhorized by the owner o(this property to perform the work for which application is made and I comply with the <br /> , Slate Contractors Law 1827 RCW and 296.200 WAC. i <br /> � �-+-.�y.v� � ''/��.,�-�ay 7 -CJ) "�0S � <br /> ignature of Owner/ ontractoriAui onzed Ag Date <br /> c%� <br />