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P�RMIT APPLICATIt,IV , b�7��� <br /> CITY t�F EVERE � T PERMIT SERVI�ES <br /> 32U0 CEDAR STREET, EVERETT, WA 98201 / Q C0� 3�> <br /> 425-257-8810– FAX 425-257-8857 –www.everettwa.org ( /✓b � <br /> r�.PPLICATIONS ARE ACCEPTED FROM 8 AM ''O 4 PM - DE[31T& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.q PEF'MIT# <br /> 51�,�t Eve�� �e�� 1;�;� �0� �, l�l b00U �i`�OU �>�� 9�� <br /> LEGA LOTNO. BLOCK TRACT SUu,�I\ k���l�Q,J�(� �N(�ti.��I.�JyI <br /> DESC. � <br /> OWNER A�ORESS CI lZIP PHONE <br /> TENANT NAh7E CONTACT FOR PERMIT PHONE <br /> L�1�t'� �.l I�L�S�,�,1.1,'� '�u�'� ( �>s� � �,tQ,� S� —GI.(. ''aOGJ (D0� ,�i� �f � <br /> CONTRACTOR �`11�j�Y, � j'�util5 Il1ec1�ADDR�cSS�U„� 6 A�V(10:�,�' S°0 CiTY21P PHONE � <br /> � `° J .Se2� �j�l(�� �o� `1a3 lao3lu <br /> CONTR.LICENSE# �� t �JJ�S� �t /. � l,� A I J /I /SC <br /> �`y l .,ll➢ ..c <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ��JS�a�I�V�1� _Electric �Gas_Other � I� � O �Q. b� <br /> WORK DESCRIPTION <br /> yi�5�- �u l� "�W o t'1 e w �' o���l o p A"�C l.� � i�5 l,� i�ti <br /> �ssc� c� 2�d' d!� c(: w��(�. ' <br /> — PLUMBING MECHANICAL <br /> NO. I TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM — <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavalory(wasli basin) � Gas piping <br /> Shower Water healer <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> � Dishwasher _ Gas range <br /> � Clothes washer ,_ C�othes dryer <br /> Laundry tray _ Range hood <br /> Sink(service/bar/mop/etc.) _ Exhaust fan <br /> _ Backflow preventer / Heat pump � <br /> Unnal _ Unit heater <br /> Dnnkin� Fountain Boiler <br /> Floor drain t � � _ Refrigeration <br /> — Grease irap �(\� � C�l,] � _ Woodstove <br /> � Roof drains U �v _ Other <br /> ' t"itier (���y — <br /> j — `\.J — _ <br /> � CITY OF EVERETi LOCAL SALES TAX CO�E IS 3'I05 <br /> I hereby ceritify th2t I have read and examined lhis application and knuw the same to be irue and correct. All provisions of laws and <br /> ordinaces governing this type of work�.vill be ccmplied with�vhether specified herein or noL The granting of a permit does not presume <br /> to give authonty to violate or cancel the provision of any other stat=or local law regulating construc�on or the performance of <br /> construc;ion. That I am authorized by the owner of this property to periorm the work for which application is mad2 and I comply with the <br /> State �ontractors Lav+ 1 27 RCW and 296200 WAC. <br /> ' (?�- ' ` �1.���U,cQc. �I - �`� -o��' I <br /> Signacure ot GwneuC ntractorrAuthonzed Agent Date � <br /> Z <br />