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FcRMIT �PPLICATIvN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 42:5-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FRONI B AM TO 4 PM f � 2.I —D7 <br /> SITE ADDRESS /� ,^ PARCEL TAX I.D.� P/ERMIT# <br /> � J I J�V.�. �.'���'q CI�� OD.� D U ( /��D/ -�/Z <br /> LEGAL LOT N0. BLOCK TRACT OR SUBDI\'ISION# ���� Ruaos <br /> DESC. 5 �' _ <br /> OWNER ADD E ` \� CI7Y21P PNONE <br /> � L. 1 � <br /> R b � rrrmr� ,�������„v,�n��,! ,�,,� cy�� a �� <br /> TENANT NA 1E CONTACT FOR PERMIT PHON '36D �3� � � <br /> SP�� � D�l�1�S YC.J SIlQ1rWUl/(J�' E.MAIL <br /> C�NTRACTOR ADD'I!_O'7' C�U� J�Cr�� �\t�S�����1S H NE <br /> Si�r�ood ¢ 1��s�h Cons�-. r�� v 1'�+- (3t�)�31 89801 <br /> CONTR.UCENSE#���n�L����� � /n/2//0� C�S') zZDsb'�3 <br /> K ( I �{$�5� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �QS� I��� �Electric _Gas_Other /+' ���OOD <br /> WORK DESCRIPTIO�I ��p�k (c� �(Q, �. J � `N� �.(�I(�S- �1�4� �7'�II f�(%�'1 � � I <br /> Rrzmo,� �, re fl o�c� i-i�d�� cA�lin�- �n%����I�v.;z cAb`r�}s '�n l�+-cl�r — �n��ll -�hres� �t�; <br /> 0��f��r do�fS- �Pen ron-bt,� n w�ll �.�� -fo dinin -�ar �,�SS-�tirJ. o�� n�,�-1'�,��iny <br /> ,�:c.11 }���„ 1:;��1�r -I� ta�l_ ^ � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel _ A/C—air ha�dlinc� units <br /> 8athtub Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> �_ Shower = Water heater <br /> _L Kitchen sink&d�sposal _ Gas fireplace <br /> � Dishwasher Casrange <br /> � Clolhes washer _(_ Clothes dryer <br /> _J_ Water heater � Range hood <br /> Sink(serviceibar/mop/elc.) � Exhausl fan <br /> _` BacAOow preventer _ Heal pump <br /> Urinal Unit healcr <br /> Drinking Founl2in Boiler <br /> Floor drein Re(rigeralion <br /> Grease lrap Woodstove <br /> Roof drains Olher <br /> Olher <br /> _ —1 — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify tbal I have read and examinad lhis application and know the same to be true and correcl All provisions of�aws and <br /> ordinaces governing Ihis type of work will be complied with�vhether specitied herein or noL The granling of a permit does not presume <br /> to give aulhori:!to violale or cancel the provision of any olher state ur local law regulating conslruclion cr the peAormance of <br /> wnstruclion. Thal I am aulhorized by the owner of this property lo per(onn the work for which applicalion is made and I comply with the <br /> State Contractors Law 18.27 RCW �nd 296.200 WAC. <br /> �'t�C)/��'114 a�i�� 1';��� D� <br /> Signal e o OwnedContfaclor/Authonzed Agent Date I <br />