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PERMIT APP'LICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM <br /> SITE ADDRESS PARCEL 7AX I.D.# <br /> „ ERMIT# <br /> I�I�. �'���y�1', �. :V ; �f� i i; � ' . . -. Uo�{ ti��`loo�o � � „�� S (,�07 — OC� <br /> LEGAL LOTNO. BLOCK / TRACT v 1 <br /> DESC. �I <br /> OWNER ADDRESS CITYlZIP PHONE <br /> „� <br /> � ill){ 'il��i�� .�I < � ���� .'..����1 i��.� CI '�Y�.� li �'�/ {. i// '� 1_. f� (?:�� lt •{ �� �' ..-I'1..: �.'�' <br /> TENANT NAME I CONTACT FOR PERMR PHONE I <br /> CONTRACTOR ADDRESS CI7Y P PHONE <br /> �'r' f� ��+. r !� C0 . �G �py I��`I 5"1 1Yl� I��Ycc(� d..5 ��1c? �; �•"� <br /> CONTR.LICENSE# ��> -t- ,7 <br /> (. �, �_��- �-� �� Z r�'i '� ��-�6 -o i <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> , �,: ._,��,- � ilj � i r - <br /> "� � ��')I'� � � i�>> � � ''- � _Electric _Gas_Other ' '" "� ._ - <br /> WORK DESCRIPTION <br /> �� � �.'�,�, c, i�y��..f� �19 c��vv� � � {��tiiv ��o�.;, r ���rlili , �,-� ;� _ ;i � �i�ck�;,- <br /> I+, �, ,��i �� ��( ra'r ��o� t },�, !-!,�cc; Noti�lV� �r,�'il � yc,movc �. - � <br /> I , ' � �� Icli <br /> ( I�/ IL ) toi�l < ff `ibv (,�P�'rc��c ' �� 'GI�- � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR REM NO. TYPE OF FIXTURE OR REM <br /> _ Toilet AIC-air handling units <br /> _ Bathtub Forced air systems <br /> _ Lavatory(wash basin) Gas i <br /> P P��9 <br /> _ Shower Water heater <br /> _ Kitchen sink 8 disposal Gas fireplaco <br /> _ Dishwasher Gas range <br /> _ Clolhes washer Clothes dryer <br /> _ Laundry tray Range hood <br /> _ Sink(service/barlmopletc.) Exhaust fan <br /> _ Backflow preventer Heat pump <br /> _ Urinal Unit heator <br /> _ Drinking Fountain Boilor <br /> _ Floordrain Reirigeration <br /> _ Grease lrap Woodstove <br /> _ Roof drains Other <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I heraby cerilify ihat I have read and examined this application and know the same to be trve and wrrect. All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whether specified herein or not.The granting of a pertnit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law reguiating construction or the performanco of <br /> construction.That I am authorized by the owner af this property to perfortn the work for which application is made and I comply with the <br /> Slate Contractors Law 18.2?RCW and 296.200 WAC. <br /> �, � �) c7�_ �`2' .� E��,�>i l.-1 7' Z�'�2J04- . <br /> Signature of OwnedContractor/Authonzed Agent Dato <br /> I - -- `�Z <br />