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P��RMIT APPLICATIO�N <br /> CITY OF EVERETT PERMIT �ERVICES <br /> 3200 CEDAR S7REET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 4�5-257-8857-www.everetiwa.org <br /> APPLICA'?lL'NS ARE ACCEPTEO FROM 8 AM TC 4 PM _ � .L \ ,' „� <br /> ��— <br /> SITE ADDRESS PARCEL TAX I.D.# ! PERMIT# <br /> 16 � ' ` cc w'. G/v --- - _� r' Oq � 2-Cr,�S <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYIZIP f HONE <br /> Kr��"��NrC� /,���_���r�.� �-�i,�r�l/ 5``Zv (.{L,1�- 3�/�-L( <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> E•MAIL <br /> ONTRACTOR A� ESS� �� P 2 � ���0 <br /> �E'�tC���'l��,l;� �S'G I 1 S /�2 S f `�� t- �'G-�� <br /> CONTR. LICENSE# <br /> �'r��,L�/�9,s',ks <br /> USE OF BUILDING HEAT SOURCE � CONTRACT PRICE OF WORK <br /> :ledric Gas Other <br /> WORK DESCRIPTION � � � . /� ���y� <br /> 1Jylt.'rl�,'r�j �-C'�� C�4/�i Sy/.;cc ;rc�.. � �:P-4✓p�- � � <br /> P!UMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel � A/C-air handling unils <br /> Balhtub Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower W ater heater <br /> Kilchen sink& disposal Gas fireplace <br /> Dishwasher � Gas ranc�e <br /> Clothes washcr Clolhes dryer <br /> Waler healer Range hood <br /> Sink(service/badmop/elc.) _ Exhaust tan <br /> Backflow prevenlcr _ Heat pump <br /> Urinal Unil heater <br /> Drinkinc� Fountain Boiler <br /> Floor drain Refrigeralion <br /> Greaso trap _ Woodslovo <br /> Roof drains Other <br /> _ Olher I _ <br /> �tl� C'� 4-ii�i� — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerili(y lhal I have read and examined this applicalion and know the same lo be lrue and correct. All provisions of laws and <br /> ordinaces c�o+erning this type of work will be complied with whether specified herein or not.The granling of a permil does nol presume <br /> l0 9ive aulhoriry to v'elate or cancel lho provis�nn ot a�y other state or local law regulating consWction or the performance o( <br /> consiruclion.That i m aulhorized by lhe oyyy���er of this propeAy to per(orm lhe work for which application is made and I comply with lhe <br /> Slale,C-�nlrectors La v 18.27 RCW and 29�0�WAC. <br /> / . ` Z_ 2�_u� <br /> Si nature of UwneT7Conlraclor/ ulh nzed Agenl Date <br />