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PEt2MIT APPLICATION <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 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL T/�(I.D.1� PERMIT# <br /> w�, �o39Z -ao�-oo -aa ° �o.� -/3 <br /> LEGAL LOTNO. BLOCK TRACT yl <br /> DESC. � � PV I �_. �1 ✓/S 1 O!1 �D�f�F Z <br /> OWNER ADDRESS CITYIZIP PHONE <br /> (', �eri� 1`'�or2 �OAA 112�1 3�`k� I� I�i �� �C �uc�2..F7'� cJr�`,� <br /> TENATJT NAME CONTACT FOR PERMIT PHONE <br /> Ci �pv�n� 1�o2(,�A,J G��n�J l�o2G� y�s=345''S187z- <br /> CONTRACTOR �p�(i,�q� ���s71TIC ADDRESS (12-�-1 3h'K"D�LSE dTYlZIP ��HONE KzS:3Vyy�72 <br /> CONTR.LICENSE# �OY�j�C�qSCUZ <br /> USE OF BUILUiNG HEAT SOURCE I CONTRACT PRICE OF WORK <br /> 5//1 � �-r M'+� � /Yt S/�/�+�4C� —Electric �Gas_Other ,�/5�•00 <br /> WORKDESCRIPTION A�(r,{' / WGI/c .;� C/oSc�s /�Q�/,/ / �1/�uJ ,tSa �roo�+7. �.I.� <br /> �,r.c,�2.,J �eoi� / �4�/� 50 .F'e.�T cuAcc . ��lt� Tulo �'..J Doo�eHF4. fAc�af,(ilu� <br /> a�Si�C2y 4u�u,S�'- /Mod� �/o.rse � <br /> �,�/,�i/ � i I �lJrM �lf��� �l�, �' �'d <br /> PLUMBING MECHANIC L <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> �� Toilet A1C-air handling units <br /> Bathtub Forced air syslems <br /> � Lavalory(wash basin) Gas piping <br /> Shower / Water healer <br /> Kilchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer � Clothes dryer <br /> Walerheater � , ,j" . Rangehood <br /> Sink(servicelbar/mop/elc.) �. ` �� ; _{_ Exhaust(an <br /> _ BackOow preventer �` ' `�� — Un t�he eP <br /> Urinal . <br /> _ Drinking Founlain � ' Boiler <br /> Floor drain � Refngeration <br /> Grease trap �Voodslove <br /> Roo(drains Other <br /> Other <br /> CITY OF EVEREiT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerili(y thal I have read and examined this aoplication and know the same lo be true and correct. All provisions of laws and <br /> ordinaces goveminc�this type of work will be complied wilh whelher specified herein or not.The granting of a permit does not presumo <br /> to give aulhority lo violate or cancel the provision o(any other slate or local law regulating construction or the performance of <br /> conslruclion.Thal I am aulhorized by the owner of lhis property to perform the work(or which application is made and I comply wilh the <br /> :>tale C raclors Law 18.27 RCW and 296.200 WAC. <br /> !w, a' a � Loo� <br /> Si�nature of OwnedConlract r Authonzed Agenl D te <br /> � �Z <br />