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i>'�I�,y r,� . �:��vri �—t.V . <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVLRETT,WA 98201 <br /> 425•257-8810—FAX 425•257-8857—www.everettwa.org <br /> APPUCATIONS I1P.�ACCEPTED FROM 8 AM TO 4 PM �'� � —� <br /> SITE ADDRESS PARCEL 7AX I.D.p P RIJIT!t <br /> . - -i ^ ^J' <br /> �_ ��.i � 1 �_{�i ��;.- �. �� il�. li� �i�;' � � . '°� �..1: '�I v �. U��I 'LV� <br /> L[GA LOT NO. �� BLOCK TRACi OR SUBDIVISION N <br /> DESC. <br /> UWNER ADDflESS CITY2IP PHONE <br /> ,. _ �.. � , � ,.,,os--�-4 `�;3c f <br /> �,� � -,- ��1� ,1'`,,., ' LL� t' �. f�,v%. ; .,- :,-7 �, ;_� t� <br /> TENANTNAME I CONTACTFORPERMIT PHONE _.,,, �.�a." '����.!(i <br /> _ ' <br /> �'' Y � t I� ��.��1(,�� �/I�t I�".���' y I�����i1�� EdY1AILci'�Y Y' !^'1'-_i1?. �a I :a i .ielj��- <br /> r <br /> L�bATR7CbT61�^�t;V�� ��yt.`1;Ifll(<il <br /> CONTR.L�CENSEp � �..`,y :_� 1�� I��`�IPr �/ I��"•�1� �—'. 1 I <br /> FtUl�,i ,ki�1 :ii�r��,�, i ^ � , _ b.• . � '� ;t ^_�- <br /> USE OF BUILDING I — HEAT StlURCE I CONTRACT PRICE OF WORK <br /> Electnc _Gas_Other � <br /> cd � 0�? r _ <br /> WORK OESCRIPTION � <br /> lr ,�;,-aiI 1 `;,i�,l- , i cli :liw:� : I'�;,f �r� d � 1� .�. Vr�:+ k �� � � <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FlXTURE OR ITEM NO. TYPE OF FlXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air sysloms <br /> Lavatory{wash basin) _ Gas piping <br /> Shower Waler heater <br /> Kilchen sink 6 disposal _ Gas fireplace <br /> �_ Dishwasher _ Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> _j_ Sink(servicePoar/mop/etc.) _ Exhaust tan ' <br /> Backflow preventer __ Heat pump <br /> Urinal _ Unit heater I <br /> Drinking Fountain _ Boiler , <br /> Floordrain _ Relrigeration <br /> Greasetrap __ Woodstove <br /> Roof drains Olher <br /> = Other iC.. �i of: : t� — — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritity that I havo read and ezamined this applicalion and know the same to be true and correct. All provisions of laws and <br /> ordinaces govorning this typa of work will be complied with whelher specified herein or nol.The granting of a permit does not presume <br /> to give auUionty lo violalo or cancel ihe provision n(any othe�state or Iocai law regula6n{)cons�ruction or the performance of <br /> construction.Thal I am authorized by the owner of this properry to perform the work for which application is made and I wmply with the <br /> Sla�o Contracrors Law 18.27 RCW and 296.20D WAC. <br /> ( � � ' , (.� �i' ( 1 <br /> � � ��.�i ii�;. , �. �:�, , . �c. <br /> Signature af er� pntractorlAulhonzed Agent ate ' <br />