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; , <br /> - P�r2MIT APPLIC�►TIO��i <br /> CITY OF EVERETT PERMIT SERVICES <br /> 32�0 CEDAR STREET, EVERE7T, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS �'/Y �V,�,r���,� lU PARCEL TAX I.D.# PERMIT# ` �/v <br /> �n�'d :i �✓. � l fn/ �' -'20 i � /� <br /> LEGAI LOT N0. BLOCK TRACT OR SUBDIVISION N � <br /> DESC. <br /> OWNER � ADDRESS CITYIZIP PHONE <br /> �v P/�u,�'l�� C°�L, . <br /> TENANT NAM , � ��nQC � � � CONTACT FOR PERMIT PHONE ����– 2 L(('--6-�L� �y <br /> V��� I � <br /> t--NU.�✓ � %✓•'-i✓ y�,�� �-JNG(" I�!I,�i' E-MAIL <br /> �-FlTRA T R y ADDRE S �,T IT IZIP PHO ����_ �; ? <br /> ���;i fFt f u n i�/ttie h-7�� /D Gf u / �YY'�C I.� �c,s-f�G �J �T�' _ - <br /> CONTR. LICENSE# L�� :.ic1,./C/ �f� <br /> �7r'�-fitC_s1i/�%(i <-(f1 P <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas_Other ! f'a'�� <br /> / \ (1 U <br /> WORK DESCRIPTION <br /> � ,uc����;Sv�. �xi'v4�,p ��'Y/ �'0 �c,r,v, �i.c •1���✓ ��ca�y,� , <br /> l <br /> PLUMBING MFCHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NC.� TYPE OF FIXTURE OR ITEM <br /> _ Toilel _ 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 Gasrange <br /> Clothes washer Clolhes dryer � <br /> Water hea�er Range hood <br /> Sink (service/barhnop/elc.} Exhaust fan <br /> 8ackllow prevenler Heat pump <br /> Urinal Unil healer . <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeretion <br /> Grease lrap Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby�ertify that I have read and examined tliis appiication and know the same to be true and correct. All provisions of laws and <br /> ordinances governing this�ype of work will be complietl with whether specified herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating conslruction or the performance oi <br /> consiruclion. That I am authori2ed by ihe owner o(this property to perform Ihe work for which application is made and I comply with ihe <br /> Slate ontractors Law 18.27 RCW and 296.200 WAC. <br /> � _ ���---._..__ �_ ,�la� /�v�v <br /> Signalure of OwnedContraclodAuthon�ed Agent Date � <br /> � <br />