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C�-ai -o5 <br /> P�RMIT APP�ICATIvN � <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 /> �- I l APPLICATIONS AFtE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED I <br /> S�TE ADDRESS PARCEL TAX I.D.# P MIT# <br /> ��-� Go I b /-1 V C.. 1��!c ' � <br /> LEGA LOT N0. � BLOCK TRACT <br /> DESC. <br /> OWNER ADDRE55 CITY/ZIP PHONE <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> ���R ' �+ I � (4z�) Z�; Z - .3/iy <br /> - -tr 5�w, �{ K�.N ��, <br /> CONTRACTOR �- qDDRESS CITY2IP PHONE <br /> C-��� ��z s/M n � y� z,`z -���[1 <br /> CONTR.LICENSE# 'LI� 1 '�u'��-,�- «T��lY2V� r <br /> CV�2(�SSo LZc�T <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � � � !Q cx� <br /> � _ „� _Electric _�Gas_Other , <br /> WORK D SCRIPTION <br /> �u�z��sK � ���S�w � �� �ou.��l� �Y5'�w�(3J �-�'S � ('Z) uN�r Ht-Y+rizs <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> _ Toilet � A/C-airhandlingunits I <br /> Bathtub Forced air systems <br /> Lavatory (wash basin) Y< Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Cbthes dryer <br /> Laundry trey Range hood <br /> Sink(servicelbadmop/etc.) �_ Exhaust fan <br /> Backflow preventer Heat pump <br /> Unnal Z Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roo�drains Other <br /> j _ Other _ <br /> I CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I <br /> � I hereby ceritify thai I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces goveming this type of work will be complied wilh whether specified herein or not.The granting of a permil does not presume <br /> to give authonty to violate or cancel ihe provision of any other state or local taw regulatin�construction or the performance of <br /> construction.That I am authorized by the owner of this property to perorm the work for which application is made and I comply with the <br /> � State CQQn��tr ctors Law 18 7 RC�W a r2�96.200 WAC. <br /> ��^^���fi'�l ✓J. ���C..�> L7`�.j '�� J <br /> iSignature of OwnenComractonAuihonzed Agent Date <br /> �2J <br />