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I <br /> ' <br /> ! <br /> PERMIT APPLICATIUN � <br /> CITY OF EVERETT PERMIT SERNICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � _� l(.p� <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org � <br /> ,i <br /> APPLICATIONS ARE ACCEPTED FROM A AM TO 4 PM ' V^ u�� �� <br /> SITE ADDRESS fF PARCEL TAX I.D.# <br /> PERMR i1 � <br /> ` h 3z c:�,;,;r�e �n�;. C "-�� ; <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE �I <br /> I <br /> TENANT NAME CONTACT FOR/�PrERMIT PHONE ��� ���/ .�a'�1 � <br /> L:.(, ���t�cj ;. I �a_�,C5 !V'�)f., e�+a� <br /> NTRA R I L- S� _3Z1 S EC�I��,n tL iPP W Z�� n <br /> /� Iisc,,5 2 S �q A �4/ 430; <br /> CONTR.LICENSE# �1 _ � � _ � )�I I� <br /> c <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK ! <br /> �^ �� V' �� I _Eleclric x Gas_Other l a�C i <br /> f <br /> WORKDESCRIPTION I .�� / i�� �,j �,c�:,6 � f�'!v� IN �' IrJ6� lJ�l/f .^, ^. rdC� i <br /> ei1�Pi' �'C��l`�r �`� �r ,F �J 1 �Z Ar�S �I Vo�lle T6r � T6 �i;l��� 'L• <br /> r I / : <br /> (q���jC , i�G:i�•�rf •f {��iVi� rr��%Pl ��. � �. f S�� �Q ' I � <br /> PLUMBING ECHANICAL j <br /> N0. I TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel __ A/C-air handling units <br /> Bathlub _ Forced air systems <br /> Lavalory (wash hasin) _ Gas piping <br /> Shower _ Waterheater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clothes washer _ Clothes dryer <br /> Waler healer Range hood <br /> Sink(service/4admop/etc.) _ Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal ,_ Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain _ Refrigeration <br /> Grease lrap _ Woodstove <br /> Roof drains _ Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceritify thal I have read and examined lhis applicalion and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this lype of work will be compliod with whether specified herein or not.The granting of a permil does not presume <br /> to give aulhority to violale or cancel the provision of any olher slate or local law regulaling conslruction or the performance of <br /> conshuction.That I am authorized by lhe owner of lhis property to perform the work for which applicaUon is made and I comply with lhe <br /> Slate Conlractors Law 18.2�'RCI� aRd 296.200 WAC. <br /> `:n�n� ' y/ .l. � � � <br /> Signalureo�O�vnedContr�tor ' �oYize �Ag t Dale <br />