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P�RMIT APPLICATI�I <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 Ct/;,, a (l�lj� <br /> SITE AL�RESS �^ C , �v �� PARCEL TAX I.0 # I PER�� <br /> � � � ��G <br /> �w»- <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION k <br /> DESC. ^_ <br /> OWNER ADDRESS CITY2IP PHONE <br /> ��o�.�� C o <br /> TENANT NAME-� I CONTACT FOR PERMIT PHONE p 5 1 I � S <br /> ��/� �C� L�.nnorl` 4�:^7rc��r-�-.�s�a-�7.�r.o� <br /> � `�� N`��_ E-ma� � �-� r . ��� <br /> Z��A TOR ADDRESS CINIZIP P E �,�� 4�' <br /> � , ,LST �1 � � ,s� �:.����� t�� i�i �= ;����� t�� ;3�,�� ,, � <br /> CONTR.LICENSE# � . � � (,✓� � SC � L �S <br /> , 25 i c��' � `5 t f�- � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Electric _,Gas_Other Z` �����jv <br /> WORK DESCRIPTION . <br /> ��� � 1���.� Si.� ('Lc_._S'�p0 n�t J <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM i <br /> Toilet _ A/C–air handling units <br /> Bathtub __ Forced air systems <br /> Lavatory(wash basin) _ 6as piping <br /> Shower _ Water heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clothes washer _ Clothes dryer <br /> Water heater _ Range hood I <br /> Sink(service/badmop/etc.) _ Exhauslian <br /> BackFlow preventer _ Heat pump <br /> Urinal _ Unit heater � <br /> Drinking Fountain — BO1�ef <br /> Floor drain � _ Refrigeretion <br /> Grease trap _ Woodstove <br /> Roof drains . Other <br /> Other _ — <br /> CIN OF EVERETi LOCA1.SALES TAX CODE IS 3105 <br /> I hereby ceri[ify that I ha.e read and examined this application and know the same to be We and correct. All provisions of laws and <br /> ordinaces governing this rype of work will be complied with whether speci(ied herein or not The granting of a permit does not presume <br /> to give authorit o violate or cancel Yhe provision of any other state or local law reyulaling construction or the performance of <br /> conshuction at I am authorized by the owner of this property to perform ihe work for which application is made and I comply with the I <br /> � S+.ate Contf�ctor�w 16. �nd 19620G V.�AC. <br /> �;�/, �� /— ��° 2 _ �e� � <br /> Si ure o Ow _ ,C trac r/t�i A�th6rized i�.geni � Date <br /> L�-- -- - — �— <br /> i <br />