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PE�rtMIT APPLICATIOtv <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � Z "a 6`�6 <br /> 425-257-8810- FAX 425-257-8857 -www.everetlwa.org �� , <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> P� �,�� _ �� � <br /> �---�- <br /> SITE ADDRESS PARCEL TAX I.D.# PE�Iy�T�� �� <br /> �� J � f/i. � /.5�., <br /> /-, p�/ Sl/�rJ 2�i� S—O X/Lv � J <br /> LEGAL LOT N0. BLOCK TRACT L� oF Q�f��7��Sjv,✓ <br /> DESC. �fG �� / /vo/ ' � � <br /> OWNER ADDRESS � CITY2IP FHONEy3,,,�aj'�f� -�r <br /> �"P����s-� /��i,J� /�v� /y ���"E��.�" lE'2o� <br /> TENANT NAME � p I� CONTACT FOR PERMIT PHONE <br /> � �)S 7S �/ �s�;U��F�� y�s=�,��3d�� <br /> �) ��ONTRACTOR �O f� � sy' CITYI7`P�G PHONE <br /> � p�s� /N�. / / f�vr� S S', .4.41,��"�i✓ 9 <br /> CONTR.LICENSE# <br /> .dK. Ss�v��/�oG�r/ ��0-�'7�i'-�� �� <br /> 11SE OF BUIL I �� � — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ��,�7' .��-�-�Q� � r <br /> / O �..��� Electric �as Other J �j ��. <br /> WORK DESCRIPTION��, CjL��,:.�„o/�.� S��-+ BU� p�-+� <br /> �i r��r'��1c',r�/},r.tn�'i z�✓�//cV �v���'"J '_' 7'v/�2��� .�y�Lx�� <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 systems <br /> Lavatory(wash basin) Gas piping <br /> ower Water heater <br /> Ki en sink 8 disposal _ Gas fireplace <br /> Dish sher s range <br /> Clolhes asher Clo es dryer <br /> � Water hea _ Rang ood <br /> Sink(service �rlmop/elc.) _ Exhaust n <br /> Backllow prev^n r Heal pum <br /> Urinal /� Unil healer <br /> Drinking Fountain Boi�er <br /> Z Floor drain _ Refrigeration <br /> � Grease trap _ Nloodstove <br /> � Roof drains _ Olher <br /> Other <br /> CITY OF EVERETT LOCAL SaLES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined lhis�pplicalion and know lhe same to be true and correct. All provisions of laws and <br /> ordinaces�overning this lype of work will bn complied wilh whelhar specified herein or not.The granting of a permit dces not presuma <br /> to give aulhority to violale or cancei the provision o(any olher stato or local law regulaling conslruction or the performance oi <br /> construclion.Thal I am aulhorized by the owner of this property to perform lhe work for which applicalion is made and I comply wilh lhe <br /> Slate Contractors Law 18.27 RCW and 296.200 WAC. <br /> i/�� �%���� `� <br /> Si . e of OwnedCoNractor/Aulhonzed Agenl Dale v <br />