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1 <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 FROM B AM TO 4 PM <br /> SITE ADDRESS.1;�'�-� �-.ti-��r�:-i: i�J:= PARCEL TAX I.D.# PERMIT# <br /> , .. M�6ce -o� <br /> � - - w� � •'r cc .1� !�'Uc��c,or, c : <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> ` _ A.-, - <br /> � - �... 1 �� � 1Jr t— L .�: .L�F L��'!—I��J''! � 1V'.; �"V::1-G=I__ '-I'r�.:c''� ;'�c. T>.:2<-' <br /> TENANTNAME ' I CONTACTFORPERMIT PHONE ^ ' <br /> �- • � l �^ t -1�' —L �1.:�� '��':" :��_�c' <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> ^l��'�.".I._a .� �f�'-� �,.1�.1.�it \ i�� .� 11t1i_ j�>i� '� U.,�_4,llJ�.i �:. \ .-J.�J <br /> ^ i:�...��'J-• . ,�.,:Jti�i.-.,�,: � 1 -='�� i -.�L� �`-> <br /> CONTR.LICENSE N � , <br /> �i_I�. -. 1 � \ � `�! '� L .� ..,.-. ��'» <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> _Electric �Gas_Olher �y _ � <br /> �!' " - <br /> WORK DESCRIPTION . , , <br /> I �, , .��.-� J:._ . i ��'-� L-�� L- �->>•-� I '� �_L 1_:�.,.:\..-_ <br /> U�/�/� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR REM <br /> Toilet A/C-air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Waler healer <br /> Kitchen sink&disposal �,_ Gas freplace <br /> Dishwasher Gas range <br /> Cbthes washer Cbtf,es dryer <br /> Laundry tray _ Range hood <br /> Sink(service/bar/mop/etc.) _ Exhaust tan <br /> Backflow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roo(drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y that I have read and examined this cpplication and know the same to be true and correct. All provisions o(laws and <br /> ordinaces governing this type of work will be complied with whether specifed herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any olher state or local law regulating construction or the pedormance of <br /> construction.That I am auihorized by lho owner of this property to pedorm the work for which application is made and I comply wilh the <br /> State ConUactors Law 1827 RCW and 2962DO WAC. <br /> �_� '—' /'� . � . ; ,�,-�: ,i �c':�.. <br /> Signaturc of OwnedContractor/Authorized Agent Dat <br />