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, <br /> � �d ��'� <br /> PERMIT APPLICATION �G, <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 ,,C � <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org ��� - ✓� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> �U �` ooyy290 aoo�oo (oo - av <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. 7� p II 12 �3 �D�J D�OD <br /> OWNER ADDRESS CITY2IP PHONE <br /> �/i�,P��'�1� �k��,oTrss <<e 60�� �� ��_�.� ,a�� �e �»aZ - <br /> TENA T NAMF I CONTACT FOR PERMIT PHONE <br /> � �uti��`�«'� .�iU `7J�0�Ll.r/Y►'1 zs� —85Y��yYy Gr //8 <br /> CONTRA TOR �� 6 �.5 S �,/Vy�,rj� ApDDRESS CITY2IP PHONE <br /> S'[A� ACG�65 L 4�l bw D 35 N. G�n�rRac. ,�u� . ,��ti�t Z,3 .�'s�v�yy <br /> CONTR.UCENSE A ,� �g� � .Z �30 <br /> 4'��/9 �ufiL�Tl o3 '�SB � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Q�I�nn^}i /j��,T��C _Electric �Gas_Other `� �'�f 7 . S� <br /> ��- 5A� /r' <br /> WORKDESCRIPTION � I ,`�R� ��(,�/ ,j�'*-'z li-OR-�. F%�L.�f EXiST/�.G G- `ON �G ��f° <br /> �> <br /> I.�n.i�s (2� �"o FFeo ,vEr,� �e.�s-T�,eAn�� . Z ,us�Acc .vernl Y_ Toti AC' F�GP <br /> �+.�Nrr . �ucr Ta �aCa�ti�,�-� (zETAic sPp� . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ AIC-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 _ Gasrange �_ S <br /> Clothes washer _ Clothes dryer <br /> Laundry tray _ Range hood <br /> Sink(servicelbar/mopletc.) _ Exhaust fan <br /> BackFlow preventer _ Heat pump <br /> Urinal L'nit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain _ Retrigeration <br /> Grease trap _ Woodslove <br /> Roof dmins _ Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby ceriti�y thal I have read and examined this application and know the same to be lrue and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authorit�to violate or cancel the provision of any other state or local law regulating construction or the pedormance of <br /> construction.Thal I am authorized by lhe owner of lhis property to perform the work for which application is made and I comply with the <br /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> $Ja/o6 <br /> SignaWre of OwnedContractor/Authorized Agent Date `� <br /> Z <br />