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P�RMIT 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 �.-/�-�D`f <br /> SITE ADDRESS PARCEL TAX I.D.#� �'�>-o� ftie+2' P RMIT�1 <br /> .�? � ,>z C'a/� tidr-�yz5, z�;�3/.F� � l.� ��/ - D�s <br /> LEGA LOTNO. BLOCK TRACT ����}� <br /> DESC. � � i �� �� �G I✓�� /L <br /> OWNER ADDRESS CITY2IP PHONE 3yy,���/ <br /> �G'N ,��DPr,�/ZT?�FG� S �� (i //DZ- :Zr,��f %9�/�.���fo 9b� '7,5 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> --- �el-� �vy- 8 �s � � <br /> CONTRACTOR AUDRESS CITYIZIP PHONE <br /> �S e � -� <br /> CO iR.LICENSE# J/� �- ��� L' �/ p p <br /> �S�J.lt� �/GiL�L � � l��-7� � D O � <br /> USE OF BUILOING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �e �`�� / _Electric _Gas�Olher `��`'G' <br /> { <br /> WORK DESCRIPTION, � � �r �I �/ C/� �" ✓ � /�j ✓ <br /> /�/� Ce � �� �1' � � ' ,� �' � /J <br /> � <br /> PLUMBING MECHANICAL <br /> NO. TVPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C–air handling units <br /> Bathlub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Ylater healer <br /> Kitchen sink&disposal Gas lireplace <br /> Dishwasher Gas rango <br /> Clothes washar Clothes dryer <br /> Waten c�aler Range hood <br /> Sink(service/badmop/elc.) � Exhausl fan <br /> Dackflow prevenler Heat pump <br /> Urinal Unit heatar <br /> Drinking Fountain Doiler <br /> F�oor drein Roingeration <br /> Grease trap Woodstovo <br /> Roof dralns Othr,r <br /> Other � <br /> /` I / — <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> I hereby cerilify Ihat I havo read and examined this applicalion and know the same to be We and correcL All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whether specified herein or not.The granling o(a permit does not presume <br /> to give aulhority lo violale or cancet the provision of any olher slate or local law regulating consW��ion or the pedormance of <br /> construclion.That I am aulhorized by tho owner of this property to perlorm the work for which applic��ion is made and I compty wilh the <br /> Stale CoNredors Law 18.27 RCW and 29G.200 WAC. <br /> /L-� ti�i,��1 _ `�I � /U <br /> Signalure of OwnerlConlracto/Authorized Ag ale � �� <br />