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� - <br /> � <br /> PE'rtMIT APPLICATION <br /> CIl'Y OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 4�5-257-8857-www.everett�va.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 3 ��� ,��6 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT!! <br /> r�511 Cole� h✓eNu� OO�1h'7A - oi � • orG -oo I � (y�3 - ��- <br /> LEGA LOTNO. BLOCK TRACT�I -� � I1 1 �L 'I <br /> oEsc. �p il �- �`�. � � �hi� ! l�ry� k �AYX, �I�o.v 7,.� t�ev:er7- <br /> OWNER qDDRESS CITY2IP PNONE <br /> C.;�z��l �,ar+ �s �erzl< % �a����l� l�vr,vn:� <br /> TENANT�AME CONTACT FOR PERMIT PHONE <br /> �1b�Y� �L7��� ��,��� �I2✓-353 - (0 77 7 <br /> CONTRACTOP C�,�� ADDRESS CITY2IP PNONE <br /> CONTR.LICENSE# <br /> USE UF 6UILDING HEAT SOURCE CONTRACT PRICF OF WORK <br /> � (s'� � �) ZC Electric _Gas__Other ���� ��r�i7�� <br /> eSiDcrtce ,.�� e Awr� �� /� �n _ <br />, WORKDESCRIPTION '��p/nta_ .ul/��g� IiNs' •{✓.�n� '��e M���.G "� '{�ie I�:�3[; �0'/JJt <br /> qISC� /1II C'�IC� CL'�J-�?eL'. I•�JfS IiNO �DRhiNS PJQPSC.vY�j� /.V `�'�tP �'N:/�?l. ��C'RCC� T+�t` <br /> hyA1G+ � i�' '/NSit I�J��C i j'�•c� /N I� NP�J C�.iia�C �iYNC' WiiVIX�U'S � i�'u� l�Y.�cDA�� O� <br /> /N�Pe�K. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTUHE OR ITEtd <br /> � Toilcl A/C-air handling units <br /> �_ Oalhtub J� Forced-ir syslems <br /> � Lava,ory(wash basin) Gas piping <br /> Shower Water heater <br /> � Kitchen sink&disposal Gas fireplace <br /> � Dishwasher _ Gas range <br /> •� Clothes washer Clothes dryer <br /> Waler healer Range hood <br /> Sink(service/badmop/elc.) Exhaust fan <br /> Backflow provenler Hcal pump <br /> Urinal Unit heatcr <br /> Drinkinc� Fountain Eloiler <br /> Floor drain Refrigeralion <br /> Grease trap Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OP EVERETT LOCAL SALES TAX CODE IS 3f05 <br /> I hereby cerilify thal� have read and examined this applicaUon and know the.;ame to be true and correct. Atl provisions of(aws and <br /> ordinaces goveminy this lype o(work will be complied with whelher specified herein or nol The granting o(a peRnit does not presume <br /> to give authority to violale or cancel the provision of any other slaL:or local law rec�ulating conslruclion or lhe performance of <br /> construction.Thal I am authorized by lhe owner of th;s property to perlorm lhe work(or which application is made and I comply with the <br /> Slate Contracto s Law 18.27 RCW and 29G.200 WAC. <br /> `� , e � _ /� :1L� <br /> Signat Con r ,.t dAuthorized Agent Date <br />