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P 12MIT APPLICATIO�V <br /> CITY OF EVERETT PERMIT SERVICIES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM 70 4 PM S" , (g..{)� <br /> SITE ADDRESS PARCELTAX I.D.M PE ITA� <br /> ��'�; Ut� � � 7 S <br /> LEGAL LOT N0. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYlZIP PHONE <br /> �1l�Rl.rl2t-�� Z�TP�IL Lf,vf�e <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �M T12UNCL 1�)CTU��'� (�-i25�77� Sa� <br /> CONTRACTOR DDRESS �tZv �i� �Z CITY2IP PHONE <br /> �VE2Cr���U C�ti1},�F1(tp�' ( \` pQ <br /> CONTR.LICENSE p � ✓l �� rU-�L�i�I V �L M�UILI:i�'e0 ��OG�N'.Z e D�� <br /> tV�t3�rG �►' q 6 4..[ � <br /> USE OF BUILDING � HEAT SOURCE CONTRACT PRICE OF WORK <br /> I _ElecMc ,�Gas_Olher I�-1-i�� V �d � <br /> { <br /> WORK DESCRIPTION / � <br /> C�u�.(��. 3 2�ou✓l �i X �' ti T�,,�-1�t A6s ,p ��es� <br /> ��l S 1 rt"�l ,��t,�4�l��l�n! `-. �:�r�S ,�� ►� g' �,%,� k s -t o W n�-f-e �� n o <br /> � „� � � -�� � � -c�2 c,c. -C �ti� �5 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OP FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toiiet A/C-air handling units <br /> Balhtub Forced air systems <br /> , .r Lavatory(wash basin) Gas piping <br /> Shower -y� Water heater <br /> Kitchen sink&disposai Gas fireplace <br /> Dishwasher Gas range <br /> othes washer Clothes dryer <br /> � We r heater Range hood <br /> � Sink rvice�bar/mopletc.) � E�austfan <br /> Backflo reventer t pump <br /> Urinal Uni eater <br /> Drinking Fou in Boller <br /> Floor drain Refrigera <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Olher <br /> — — � <br /> � _ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined lhis application and know the same to be true and carrect. All provisions of laws and <br /> ordinaces governing this type cf work will be complied with whether spec�ed herein or not.The granHng of a pertnit does not presume <br /> to give authority to violate or cancel the provision of any other slate or local law regulatlng constructlon or the performance of <br /> construction.That I am authorized by the owner of this property to periorm the work for which appllcaUon fs made and I comply wfth the <br /> State Contraclors Law 1827 RCW and 296.200 WAC. <br /> �j*�/ _ 'O J/CJLl / 1�� <br /> SignaWre of Owner uthorized Agent Da l� <br />