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• / i <br /> � t <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425•257-8810—FAX 425-257•8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FHOM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.p PER IT# <br /> �� - � a=1 A . c ' 9 3'3� r�-���m 5 `��d-l� <br /> LEGAL LOTNO. BLOCK TRACTORSUBDIVISIONX <br /> oesc. 1� ) � - • � ' � +'I�� <br /> OWNER A�DRESS CITV2IP PHONE <br /> ��.ii� � �-l�C iA lo,-ln��ra I 1,'al ��i-l>>. 1=1�u_ C- ��o iai l 1l'� �le <br /> TENANTNAME CONTACTFORPERMIT PHONEL1a� _ Z�� • �j1�c� <br /> \ ��'��(1 i�l`�(�1U�Y� E-MAIL <br /> C�TRALT R DDRE ITV/ZIP PHONE <br /> L�rl'»�� 4,crY�x{':Ilrr� (G�•�, =�iY . 22_b �jl,�•, �L `�C ���.'1�( i�a,c ' 2'Z�� - �,�7r <br /> CONTR.LICENSE p �� . / <br /> tl���.� ��n,�nl,rn� �,��// �:;2� � <br /> USE OF BUILDING HEAT SOUflCE CONTRACT PRICE OF WORK <br /> �'r'� �Electric _Gas_Other �� '� � <br /> WORK DESCRIPTION <br /> �i»��rc- � �. 5rrc... v��e��,')c `)nr�i\ii)� ��t'�IIS� �itC��� L).)1 --4'�¢ (f7Y14•li. `�-{:,m 1'��115 <br /> =r:�5oli�I��c, Cx.4:�;o� 4xv�� . i���va,i I t��A —(�F.y�;l�J <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathlub Forced air sys�ems <br /> _ Lavatnry pvash basin) Gas piping <br /> Shower Water healer <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas rangc <br /> Clothes washer _ Clothes dryer <br /> Waler heater Range hood <br /> _ Sink(service/bar/mop/elc.) _ Exhaust fan <br /> Backflow prevenler Heat pump <br /> Urinal Unil healer <br /> _ Drinking Founlain _ 8oiler <br /> Floor drein Refrigeralion <br /> _ Grease trap _ Woodsiove <br /> Rool drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> I hereby cerilily that I have read and ezamined this applicalion and know lhe same to be true and correcL All provisions ol laws and <br /> ordinaces governing ihis rype ot work will be complied with whether specilied herein or nol.The granling of a permil does not presume <br /> to give aulhority to violale or cancel ihe provision o� any other state or local law regula�ing conslruction or ihe pedormance ot <br /> construclion.That I am authorized by Ihe owner o�Ihis property lo perlorm lhe work lor�vliich application is made and I comply with the <br /> I State Conlr2clors Law 1827 RCW and 296200 WAC. <br /> � /�� -J1i� -1� 1�I ��7) <br /> SignaWre of Own 'ConlracrorlAuthorizetl Agent DTale `I <br /> � <br />