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, <br /> PERMIT APPLICATIQN <br /> CITY QF 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 8 AM TO 4 PM <br /> SITE ADDRESS I, PARCEL T�l�.# PERMIT#/� !� (�� <br /> �� � V <br /> � , V <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE II.J y_ ��_ <br /> ���75hi�ii�� 01<iim ��I-fl `f�o5 i�/.<�I�r�l�c����'EJ��'r�?-�.� 9�;� ����o <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> sa��. .� �h� N-en�e,rb�n y��-'��� - v.3 v�- <br /> CONTRA:TOR yJ�IM1'U �Y.� �1 �'I �a l/��J A (C/�I�l `{�a1 /1 F--CITY2IP PHONELI�L-J 'SJ��' — <br /> �l �� l� � V �'7�ii1VV �C �'�J I /, <br /> CONTR.LICENSE p �{I'�V U NL 5 I � �CI� l I �7"VrI I I��`� V I� IU�p3 v I I I <br /> / <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ,� � - �I 7 . <br /> � � ��' O(_.�b�F��i VL �M . �Eleclric Gas Olher � � v U <br /> WORK DESCRIPTION <br /> � o►1ii-�t-f- -e,�ES-��'�'� ��-,�r{1ciC� �' Wa�'��" l�a-�" -�v � �iS <br /> �1f-�2t.P� Cc-ti�- Il��'--��� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet NC–air handling units <br /> _ BalMub j_ Forced air systems <br /> I _ Lavatory(wash basin) _�� _, Gas piping <br /> I = Shower _ � I Water heater <br /> Kilchen sink 8 disposal _�^ Gas fireplace <br /> Dishwasher Gasrange <br /> I _ Clothes washer Clothes dryer <br /> i _ Laundry tray _ Range hood <br /> Sink(service/barlmopletc.) Exhaust fan <br /> 9ack(low preventer Heat pump <br /> Un�.�l ilnit healer <br /> Drinkiny Founlain Boikr <br /> I Floordrai� Refrigcral�en <br /> Grease ira,i Woodslove <br /> i = Roof drains = Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby ceritily that�have read and examined this application and know the same to be true and correcl. All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whether specifed herein or not.The granting o(a permit does not presume <br /> to give authori.� lo viaate ur cancel the provision of any other state or local law regulating construction cr the performance c� <br /> construction.That I am authorized by the owner of this property lo peAorm the work for which application is made and I comp�y with the <br /> State Co tractors Law 18 7 RCW and 296.200 WAC. <br /> C�t� �.�^ Iv�� `f���' <br /> Sit�natu ol OwnedCon�ractor/Authonzed Agenl D e <br />