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r----- <br /> PtRMIT APPLICATIC�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 982J1 <br /> 425-257-8810- FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> ?,<.' � Ga(v.,,�,b�� /(�e -y'S"cao2 o130a y C)5'2 <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> � �'Ia�'�� a �Q� r ZIb2 C����K�JY1 92 <br /> TENANTNAME CONTACTPORPERMIT PHONE/yZS-1 (,fLf(o-Z`l�� <br /> l / <br /> I�Av ��`s'( C�QV� �SQ•[C ��I JN� E-MAIL <br /> � �dNTRA�R�, ADD S .�. T1'/ I <br /> 1 sliu � �� (•�., �1 � (P(v7. � �/7 �✓�' vv���ysd;ll� �fZs v�/� z9l <br /> CONTR.LICENSE# '" ������ "����31'�'�1-- <br /> Am r i�c y�3rnG <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �y�` d rQ e I —Electric _Gas_Other 32 OGO 3Gj - <br /> � <br /> WORK DE CRI TION <br /> �--��� I��,J �i,;�� �r f,��S�r Ci 1.� <br /> h'" � s <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handling units <br /> Bathtub Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Waler heater <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clolhes dryer <br /> Waler heater Ranc�e hood <br /> Sink(service/badmop/elc.) _ Exhaust fan <br /> Backllow prevenler _ Heal pump <br /> Urinal Unil heater <br /> Drinking Founlain _ Boiler <br /> Floor drain Re(rigeralion <br /> Grease lrap _ Woodstove <br /> Root drains Other <br /> Olher <br /> � <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> I hereby cerili(y thal I have read and examined lhis application and know the same lo be true and correcl. All provisions of�aws and <br /> ordinaces governing this type of work will be complied wilh wheQier specified herein or not.The granting of a permit does nol presume <br /> to give aulhorily to violate or cancel the provision of any other slale or local law regulaling consWction or the peAormance of <br /> conslruclion.That I am aulhorized by the owner o(lhis property lo perform the work for�vhich application is made and I comply wilh the <br /> Stale Co tNactors Law 18.27 RCW and 29G.200 WAC. <br /> . J ,I <br /> , � _, /% f,� y-iy-o�' <br /> Sign ture of Own N onlractor/Authorized A�enl Dale <br /> i(L <br /> �_ <br />