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PERMIT APPLICATIO�V s --1 --D,6 <br /> CiTY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 /B J��O�/ <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org C.0 llCi <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM D�� �(J3 'Z�� <br /> SITE ADDRESS PARCEL TAX I.D.� Pf RMIT# � \ <br /> - � D E �v�= Do ��� ��.so �3v�� � �C�o3 - 5-� � <br /> LEGA LOTNO. BLOCK TRACT � �'•v !J R � I�T <br /> DESC. �� �a j (/�' �C TI <br /> OWNER ADDRESS CITY2IP PHONE <br /> �.�-v,�� P� � ,��a� 3��� ���u�� ������,� �1�3 ��r ��� <br /> TENANTNAME CONTACTFORPERMI PHONE <br /> �'�,� ruc ,.�K� ��as - 330- �y� <br /> CONTRACTOR ���SS C(���� CO. ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE# �'f�Cs$ C� `l°(�Q �i //iZ- /�� t`!� � (J-. /��'" `��S 330 �`/�'6 <br /> 9�.�a3 <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ,S(n'f l� -FC��u� �cL I _Electric _Gas_Olher � �� � (J�d <br /> /! <br /> WORK DESCRIPTION <br /> (�c: bv� 10� l-���s� ( `{-�rc� j ��7�/ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilel A/C-air handling units <br /> � Balhtub Forced air systems <br /> � Lavalory(wash basin) � Gas piping <br /> Shower _L Water heater <br /> I Kilchen sink&disposal � Gas tireplace <br /> � Dishwasher Gas range <br /> � Clothes washer � Clothes dryer <br /> �_ Waler healer Range hood <br /> _L Sink(service/badmop/elc.) �_ Exhausl fan <br /> Back(low preventer _ Heal pump <br /> Urinal Unil healer <br /> Drinking Founlain _ Boiler <br /> Floor drain Re(rigeralion <br /> Grease Irap _ Woodslove <br /> Roof drains Other <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify thal I have read and examined lhis applicalion and know lhe same to be lrue and correcL All provisions of laws and <br /> ordinaces goveming lhis lype of work will be complied wilh whelher specified herein or not.The granting o(a permit does nol presume <br /> lo give authoriq�lo violate or cancel the provision o(any olher stale or Iocal law regulating consWction or the pertormance of <br /> conslruclion.That I am aulhorized by Ihe owner of this property to perTorm lhe work(or which application is made and I comply with lhe <br /> Slale Conlraclors�,aw 18.27 RCW an 96.200 WAC. <br /> / <br /> ��' /��j: � 3 --,,��- aG <br /> Signatu e o( wner onlractodAuthorized Ac�ent Dale I/ <br /> c�..- <br />