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PtRMIT APPLICATIUN <br /> C1TY 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 8 AM TO 4 PM �� �g-O9 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> �I Cc ��� C �[��� —015 <br /> LE AL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CINIZIP PMONE <br /> �� I(i f'l 5�1 ��t ��f-'/Cfl <br /> TENANT NAME CONTACT FOR P MIT PHONE //?,_��1 ��� <br /> � L / <br /> � ,� E-MAIL ��t'/i��i ��tT�- <br /> irrrz <br /> CONTRACTOR S G3/1• y1�j <br /> ��,y'rl�-'j-CL':� �. � Uy7lti/i�� •���i � �j � — ����11--�1�3',f��/S <br /> CONTR.LICENSE# �- d� I��� t�l �`� !�'�'.Lf/ LJ���j/ <br /> �!'% � � )4�'1�l�' ' � <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> b <br /> Electric _Gas_Other ! 'L�.r�'�1. `2 <br /> a�t"�,f�-f'/c t F — <br /> WORK DESCRIPTIOh <br /> � � � � ��Z���l'<1"lGc� �U�� <br /> �G� �,� �i�YLi 9�'l�//r,� �� � � <br /> PLUMBING MECHANICAL <br /> NO. TYPF OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM � <br /> Toilet _ A/C—air handling unils <br /> Bathtub _ Forced air systems <br /> Lavatory(wasli basin) _ Gas piping <br /> Shower _ Water healer <br /> Kilchen sink 8 disposal _ Gas(ireplace <br /> Dishwasher _ Gasrange <br /> Clothes washer _ Clothes dryer <br /> Water healer _ Range hood . <br /> Sink(service/bar/mop/etc.) _ Exhausl fan <br /> Back(low prevenler _ Heal pump <br /> Urinal _ Unil heater <br /> _ Drinking Fountain _ Boiler <br /> Floor drain Re(rigeralion <br /> Grease trap _ Woodstove <br /> Roof drains _ Other _ <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TN(CODE IS 3105 <br /> I hereby ceriti(y Ihal I have read and examined this application and know the same to be We and correcl All provisions of laws and <br /> ordinaces goveming lhis type of�vork will be complied�vith whelher specified herein or noL The granting of a permit does not presume <br /> to give aulhority lo violale or cancel the provision o(any other slate or local law regul, ting construclion or lhe peAormance o( <br /> conslruclion. Thal I am authorized by lhe owner o(lhis property to pedorm the work for which application is made and I wmply wilh lhe <br /> Slale Conlractors Law 18.27 RCW�and 296.200 WAC. <br /> �j '----^------ [/�° �J�l(9C� <br /> Signature o(Owner/�onlractor/Aulhorize gepl— � `p��e T-� / <br /> � <br />