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PEKMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES 3-10�6 <br /> 3200 CEDAR STREET, EVEf�ETT,INA 98201 �(/� <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> �'�(J 1 Os -03 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX�.D.# / PERMIT� <br /> l� .S � � .O L /� � �/E C'U l� �' l � _�� � ��� o,rt• - C b �y�� � � <br /> LEGA LOTNO. n k BLOCK T/RA�CT <br /> DESC. C�,�j��.0 �D � r o �.c' r ,�� r J? <br /> OWNER ADDRESS CITY2IP PHONE 7f <br /> ��,N /'� ,r r� cs.r �.r� � C'.� ���1 �} �� t C"v C� F�;�,`'',� � �.��.�.��,� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> N /1 ,� /�/`t [' C� �� c LI ;��I �� Z f L4 <br /> rT <br /> CONTRACTOR C�v�� �/� ADDRESS CITY2IP PHOKE <br /> i\ <br /> CONTR.LICENSE p <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � �'Eleclric _Gas Olher <br /> ��/� (71ciVqLCld[�/C� .1��1/i�C — — <br /> WORK DESCRIPTION `/ N f S f I ��-r� �CN'l �C�' /�� Q r7`� �/} � � i ✓i N� <br /> r <br /> /� <br /> s�',a cr- ; ti-c� � �,� ,.v�, K��r c �-���� a l�� Tr-I ,rs�: <br /> PLUMBING MECHANIGAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toiiel _ A/C—air handling unils <br /> � Balhtub _ Forced air systems <br /> �_ Lavatory(wash basin) Gas piping <br /> i,j_ Shower � Waterhealer <br /> � Kilchen sink R6isposal Gas fireplace <br /> Dishwasher Gasrange <br /> I Clolhes washer �_ Clolhes dryer <br /> �_ Water heater t Range hood <br /> Sink(service/badmopletc.) �_ Exhaust fan <br /> _ BackOow preventer Heat pump <br /> Urinal /� Unit heater �� .fC /.f�•'��f � <br /> Drinking Fountain � Boiier <br /> Floor drain Refrigeration <br /> Grease Uap _ Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> i hereby centify lhal I havo read and examined lhis application and know Ihe same to be We and correcL All provisions of laws and <br /> ordinaces governing Ihis type of work wili be complied with whelher specified herein or noL The granting of a permit does not presume <br /> to give aulhority to violate or cancei Ihe provision of any other state or�ocal law regulating wnsWclion or the pc�dormance cf <br /> construcliun.Thal 1 am aulhonzed by the owner of this property lo perform lhe work for which applicalion is made and I coniply wilh the <br /> State Conlraclo s Law .27 RCW and 2962DO WAC. <br /> �-�// c r <br /> �./� ,.«-<< ( ._ (3 �c� � , <br /> SJqhaWre�(Owne ContractorlAulhonzed Agent Date /Ti <br />