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PtRMIT APPLICATIGN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-R810— FAX 425-257-8857 —www.everettH•a.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �Z �ZZ-0� <br /> SITE ADDRESS - PARCEL TAX I,D.# PERMIT# <br /> �3i � 1���,a �� � c��rl�-c�3 <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION q J � � <br /> DESC. (/J.�� �'S�I'���Z� <br /> OWN=P. �z�L t"���� �,/����R��ADDRESS CIN21P PHONE I <br /> .� � � <br /> Z >/ y�_c�f 1; 1��/ic- c I, =-� v" cv <'T/` iv,, , y�? _`J�� <br /> TENANTNANE � CONTACTFORPERMIT PHONE <br /> E•MAIL <br /> CONT ACTOR ADDRESS T IZI PHO <br /> ' � c r,, :� <br /> CONTR.L�CENSE q �-- ` <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE UF WORK <br /> Electric Gas Olher <br /> WORK DESCRIPTION /'1.� �� "�� / / <br /> �) �G ��J - �f/� l.J�'n,.��-r-a...Y � /-d:%� pi�'G��Y �`tl/-'� k>Lf� <br /> ��� . / � <br /> z, � :( 1:�.� P .�c<; rf i< ,,-f7,d �E' n��1.;.,�'� <br /> / <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C -air handling unils <br /> Balhtub Forced air syslems <br /> Lavalory (wash basin) _ Gas piping <br /> Shower . Water healer <br /> Kilchen sink&disposal _ Gas firepiace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryer <br /> Water healer Range hood <br />� Sink (service/badmop'etc.) _ Exhaust fan <br /> BackBow prevenler _ !lealpump I <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease Irap _ Woodslove <br /> Roof drains Olher <br /> Olher <br /> CITY OP EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby certi(y Ihat I have read and examined lhis application and know the same to be lrue and correct All provisions of laws and <br /> ordinances governing this lype of work will be complied with�vhether speci6ed herein or not. The granting of a permil does nol presume <br /> lo give authonly to violale or cancel the provision of any olher state or local Iaw regulating construction or the perfo mance of <br /> conslruction.Thal I am au�horized by the owner o(Ihis property to pertorm the work for which application is made and 1 comply with Ihe <br /> Stale Contractors Law 1827 RCW and 296200 WAC. <br /> 'C %2'�,� ./�.,-��. f i � .��..�,� D <br /> Signalure of Owner/Cont ctorlAuth fized Agent Date <br />