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PL'��ZMIT APPLICATIG�� I� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREE T, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org � `},g�5 <br /> APPLICATIONS ARE ACCEPTED FP,OM 8 AM TO 4 PM - DEBIT&CREDR CARDS ARE KOT ACCEPTED I <br /> SITE ADDRESS PARCEL��7C I.D.p P 'itMIT N /' <br /> G'«� 3 �- G c m�' :-�4 G 4 L IWL- OGSs�`/r1 U �l ,s Po -s �`G �� lJ�� <br /> LEGA LOTNO. BLOCK TRACT <br /> DES4 �I <br /> OWNER ADDRESS CITY2IP PHONE li <br /> Cb/�t/t'1 Cru�� <br /> -.); � ���._ ,��7-,,�T�_�3��� J�3.��_ E�,��1+,� _ y-�s_a 40 - 3iyj '� <br /> TENTINTN E I OONTAC7F0 PERMIT PHONE �II <br /> CONTRACTOR ADDRESS CITY2IP PHONE � <br /> CONTR.LICENSE# �/:../, ���. �� <br /> G!/}�/ <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> \ Electric Gas Other �9�' <br /> WORK DESCRIPTION I <br /> Q�c,�, ,Cc�l-c� /.SX 24 ��I <br /> PLUMBING MECHANICAL I'i <br /> NO. TYPE OF FIXiURE OR ITEM NO. TYPE OF FD(TURE OR ITEM 'i <br /> _ Toilet A/C—airhandlingunits <br /> Bathtub Forced afr systems ' <br /> � Lavatory(wash basin) Gas piping � <br /> � Shower _ Waterheater <br /> _ Kitchen sink&disposal Gas fireplace I <br /> _ Dishwasher Gas range ' <br /> _ Clothes washer Clothes dryer I <br /> _ Laundry tray Range hood II <br /> _ Sink(service/badmop/etc.) � Exhaustfan <br /> _ Backflow preventer Heat pump <br /> Urinal UMt heater i <br /> Drinkin� Fountain Boiler <br /> _ Floor drain Refrigerallon �i <br /> Grease trap� Woodstove I <br /> 1 Roof drains. Other, I <br /> _ Olhef_��%l,(/�f�. l%1'l.(�`� � � ��'+ �C... �� <br /> ' i — <br /> CITY OF EVERETT LOCAL SALBS 7AX CODE IS 3105 �II <br /> I hereby ceritify that I have read and ex�mined this application and know the same to be true and correct. All provisions of laws�nd <br /> ordinaces governing this type of work will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating constructlon or the performance of <br /> construction.That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> State Contraclors Law 1827 RCW a 296.200 WAC. <br /> A�/�_.b'�.�� � �� �dS � <br /> �ly�lature of OwnedContrac orlAuthonzed Agent Date ��L <br />