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PERMIT APPLICATIGN <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 S AM TO 4 PM S �oZ 3 —O� <br /> SITE ADDRESS '-/e�- c S' PARCEL TAX I.D.# PERMIT# <br /> 75 C 1 bt/ t�� �l/v - E C7SSOS Ci� <br /> LEG?.L LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER AODRESS CITV/ZIP PHONE <br /> �UG. i�?G, c'oM�'�r��Y <br /> ( <br /> TENANT NAME CONTACT FOR PERMIT PHONE Gi i3 _ �[} � - 7Q <br /> �'(� f'l� 2'C�� i�c' � JlN� �nJDEic'Scs✓ e-ma� J;.Y._ /-(�:pr'vsr ,� <br /> CONTRACTOR ADDRESS CI 21P PH NE �,�E�E'iPo$ PE <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> \ <br /> pFF�GG����cCvrT �o�•-� _Electric _Gas_Other <br /> i <br /> WORK DESCRIPTION ���,n <br /> �j��' I t�\ lz �� G�' �-4 �l�F AS �j <br /> �� ��-� �� � S - �"L'IOdL� <br /> PLUMBING MECHANICAL <br /> Np, NPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ A/C-air handling units <br /> Bathtub _ Forced air sy�tems <br /> Lavatory(wash basin) _ Gas piping , <br /> Shower _ Water heater <br /> Kitchen sink&disposal _ Gas fireplace , <br /> Dishwasher _ Gas range '� <br /> Clothes washer __ Cbthes dryer �i, <br /> Water heater _ Range hood �. <br /> Sink(service/badmopletc.) _ Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal _ Unit heater <br /> Drinking Fountain __ Boiler <br /> Floor drain � _ Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains _ Other <br /> Other — <br /> I <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I here6y ceritify lhat I have read and examined this application ,�nd know the same[o be true and correct. All provisions o!laws and <br /> ordinaces goveming this type of work will be complied with whe. ,er specified her2in or not The granting of a permit does not presume <br /> '� to give authority to violate or cancel the provision oi any other state or local law regulating construction or the perform2nce of <br /> cons«uction.That i am authorized by the owner of this property to perform the work tor which application is made and I comply with the <br /> � Siate ConU cs L ,$.27 RCW and 296 200 WAC. <br /> �, _ .,- ;1 -,'_ �l z 3 /�8 <br /> � Siynat e o OwnedConlractor/Authorized Agenl —� �/� <br /> I—.-_ . ._--- - -.._ ---- -_._.__-- ---- ---- -- <br />