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F�cRMIT APPLICATII�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 93201 <br /> 425-257-8810 - FAX 425-257-SE57-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM E AM TO 4 PM g�-� u—�� <br /> SITE ADDRESS PARCEL T/ll(I.D.# PERMIT# <br /> ll� z ���.� ,�-es�, �,�J�.�-� �S 908�o¢ <br /> LEGAL LOT NO. BLOCK TRAf:T OR SUBDIVISION# <br /> DESC. �qy-q�- <br /> OWNER , 1 ADDRESS CITYIZIP PHONE �'�.-6��- SlZ <br /> t/�Sf Gt��o/G� ,�Y1 �.�C' � �� c 5Z o �. �a,�-�/�GcJ' /'i ���L��/� <br /> TENANT NAM CONTACT FOR PERMIT PHON P7 <br /> C�iJij�S T�/�E;{���} ,�' -`�� �.Cl�r4 � ���./1��'LC zv!'-�5��._ 2� 3 <br /> e ma� <br /> COpNT/R�ACT./R, /1� "� �I /� SI G�/�I I�RE �� G/.; �OX J yO �' � �� ��/ <br /> C�f�r%� // I L ✓/JI�{..'I � S ,J,C�(/ �-F9� <br /> cor7iR.LICENSE# C���i`a"�� `/ S� t� G(JL I�J�F�O z 0�' - u"�Z/ J -�1�d`' <br /> USE OF BUILDING HEAT SOURCE ���� CONTRACT PRICE OF WORK <br /> �,''� �Electric _Gas_Other �'� '� <br /> WORK DESCRIPTION J , � „ �C�I� � <br /> .i� n/) � �J' �� <br /> � 0 l �� S�C�.� �ltit, ..iX�l.�_7�u-C I�t- L� , � � �ca <br /> � ' � � <br /> ��:�1� ����a� �� J� � �X� e�uti � <br /> PLUMBING MECHANICAL <br /> Np, TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> Balntub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Water heater <br /> Kitchen sinM.&disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer _ Clothes dryer <br /> Waler heater Range hood <br /> Sink(service/bar/mop/etc.) _ Exhaust fan <br /> BackFlow preventer _ Heal pump <br /> Urinal Unit healer <br /> Drinking Fountain _ Boiler <br /> Floor drain Reirigeration <br /> Grease lrap _ Woodslove <br /> Roof drains _ Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know the same lo be lrue and correcl. All provisions of laws and <br /> ordinaces governing this type of work will be complied wilh whether specified herein or not.The granling of a permit does not presume <br /> lo give authority to violate or cancel lhe provision of any olher slate or local law regulating conslruchun or lhe periormance of <br /> conslruction.Thal I am authorized by the owner of this property lo perform lhe work for which application is made and I comply wilh the <br /> State Contrsstors Law 18.27 R�W and 296200 WACq� � � <br /> �� ��C��� � ,�u-<-�c C% v �//��� % <br /> Signa ure of Owner/Contra or/Aut�ized Agent Date � / <br /> � y <br />