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P�CRMIT APP�ICATI(�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> ��-,'1 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> (J <br /> I�APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> te�6�G-u..r (eeti. wc S �� � �O <br /> LEGA LOT . BLOCK � TRACT <br /> DESC. I <br /> OWNE1�, AODRESS CITY2IP PHONE <br /> N�uz�� ja6o3 ��u���.; �,.��Y �i��'�-� 3�- Yzti-�3zr <br /> TFNQ N�T NAME CONTACT FOR PERMIT PHONE <br /> `'V�GZ�t� I ��`l � �Yu.c � 3�` �l:L�(-�32s <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> Me��r-5��.�,-.� /�,F,,�F,s,� aGc;e Nw 9q S���� U�louu-i V,ct�,�,,� _ 1 c <br /> CONTR.LICENSE# ����5�� � � � � �� ����� � Y (-�32$— <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> Electric Gas Other 3U��v�� <br /> WORK DESC IPTION o <br /> �'tis�� St�H��\`t �c.,r ����C�Z��1 \ <br /> � V <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTl1RE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory;wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry trey Range hood <br /> Sir'c(service/bar/mop/etc.) Ezhaust fan <br /> I = Backflow preventer _ Heatpump <br /> Ur'nal Unit heater <br /> ! Dnnking f bunt2�n Boiler <br /> , Floor drain Refrigeretion <br /> � _ Grease irap Wocdstove <br /> i = Roof drains = Other_ <br /> Other <br /> i <br /> CITY OF EVERETT LOCAL SALES SAX.C6Dl_IS 3105 <br /> I hereby ceritify that I have raad and examined this applicatlon and know tY:e same to be true and cortoct. All provisions of laws and <br /> ordinaces goveming this type of work will be w.Tplied with whether specified herein or not.The granting of a uermit does not presume <br /> to give authonty to violate or cancal lhe provision of any other state or local iaw regulating construction or the peAormance of <br /> construction.That I am authorized by the owner of this property to perform the work for which applicaGon is made snd I comply with the <br /> Stata Contractors Law 1 .27 RCW and 296.200 WAC. <br /> 'lj✓����/� 02-�3, a.S— <br /> Signature of Own dContractor/Authonzed Agent Date �� <br /> L <br />