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P'�RMIT APPLICATILN <br /> CITY OF EVERETT PERMIT SERVICE� <br /> 3200 CEDAR STREET, EVERETi', WA 98201 � Z, -(O -U� <br /> 425-257-881 G- FAX 425-257-8857 -www.everettwa.org _P G��/J/-=/� �/ <br /> t� ��f� <br /> APPLIC.4TIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE A�DRESS PARCEL TAX I.D.# I P�RM,�# C / <br /> ! n �f n :L r�!o l l y Q ; c_ Gb 5�-1� 003 D U I(.� (`�v�_r (( ' � <br /> LEGA LOT NU. BLOCK TRACT I <br /> DESC. � ' <br /> % � /�i..✓ c�, L n��c r c c <br /> OWNER ADDRE55 CITY2IP PHONE <br /> J� �; C�� rct r � ���� / C��'t' /� (/i� Ir�✓ l��>r�:c�a�� /.(J� �l25 7�2 -��1� <br /> TENAN-T Np� CONTACT FOR PERMIT PHONE <br /> Si m V� �'R'f � ��f25 �7 <br /> CONTRACTOR AODRESS CITY(LIP PHONE <br /> CONTR.LICENSE p ////�� /I� \\ <br /> �W�`-�' � 4-tt .tiC �L�Li (�CJ 25�.-. / <br /> USE OF BUILDING � G HEAT SOURCE CONTRACT PRICG OF WGRK <br /> �i�� _Electric �Gas_Other <br /> WORK DESCRIPTION <br /> ����U� S���� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> .� Toilet ' A/C-air handling unils <br /> 1 Bathtub = Forced air systems <br /> �' ' Lavatory(tiyash basin) . � _� Gas piping <br /> i Shower � r Water heater <br /> Kitchen sink 8 disposal _(_ Gas fireplace <br /> ! Dishwasher Gas range <br /> �_ Clolhes washer � Clothes dryer <br /> _ Laundry lray � Range hood <br /> Sink(servicelbadmopletcJ -Th Exhaust fan i� � � <br /> BackOow preventer Heat pump <br /> Urinal Unit heater <br /> Urinking Founlain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other <br /> � I <br /> ICITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I I hereby ceritify thal I have read and examined this application and know the same to be true and correct. All provisions of la�:s and <br /> I ordinaces goveming this type o(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 conswction or the performance of <br /> I consWction.That I am authorized by the o�vner of this property to perform ihe work for which application is made and I comply with the <br /> I State Contractors Law 1/8.27 CW and 296.200 WAC. <br /> ' G� . .. (�/?T /[• /� / .Z. 0� <br /> i SignaWr Owner�Contracror/A onzed Agent D te <br /> . i ��� <br /> � ` v :;2. <br /> JN <br />