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P'�.RMIT APPLICATI(.►N <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 /> ��! � —� 1 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT &CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT#/; <br /> I ��' �11Et:.:�'� J�Ji' _ V�� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AUDRESS CITYIZIP PHONE <br /> i / <br /> S,rl% �' f'l�f� Lr�Cf`'��'LC" 7j�" i_iiY:_'F`ii <br /> TENANT NAME CONTACT FOR PERMI'f PHONE <br /> '�) i_ . _ <br /> JIJ� �:LL-.�' N�l�r'P�' Y/-$'?C�S ' � �J� <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> �-C�." ' <br /> I.-n_ ✓� < <"�'_-y �-'1�� y�,+�„-;�r��t�o:��•uJ <br /> CONTR.L�CENSE# " �I/l�•r /I l��J'j('f' -5�30�/ <br /> �lik�i�['`�` lG-1 �`� ` <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> ,/i� <br /> (��t i��': % —ElecVic /-Gas_Other ,�� i i ��= ij�� <br /> r� <br /> WORK DESCRIPTION <br /> ��.G.c% �'��v• c��L:.t r ir-/r-^-.. �;'�5if ��G"�'-/ <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. T�PE OF FU(TURE OR ITEM <br /> Toilel A/C-air handling unils <br /> �athlub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Waler heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer r� Cblhes dryer �'� <br /> Laundry tray /�/ _ Range hood <br /> Sink(service/badmop/etc.) Exhaust(an <br /> Backflow prevenler Heal pump <br /> Urinal Unit heater <br /> Drinkin� Founlain Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roo(drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> I hereby cerilify lhal I have read and examinod lhis application and know lhe same to be lrue and correcl. All provisions of laws and <br /> ordinaces gover,.ing this type of work will be complied with whether spacified herein or not.The granling of a permil does not presume <br /> lo give authority to violale or cancel lhe prc+ision of any other state or local law regulaling consWction or the performance of <br /> construction.Thal I am aulhorized by lhe owner of lhis propeRy lo peAorm lhe work for which application is made and I comply with the <br /> State•�onlractors 4aw 18.27 RCW nd 296.200 WAC. <br /> �.%//, 1 <br /> �Ll. � ,. ,�/�S' . �_ . j��'{ <br /> /'<� r % � ��"� <br /> Signature o(OWner ontractodAuthonzed Agent Date �/Z <br />