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F�RMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-25?-8810 — FAX 425-257-8857 —www.e':erettwa.org <br /> APPUCA710NS ARE ACCEPTED FROM 8 AM TO 4 PM �,..�6 —I D <br /> SITE ADDRESS� 7 {� ( �v��"� PARCEL TAX I.D.# PERMIT# <br /> � ! .. � � " ��I� 1 �`'4( �� ;� J(L. ,'!'� � ��� c� y' C�D5 �.2� �� .� =� _ � L�v' <br /> C�� � �'i� �" <br /> LEGAL LOT NO. BLOCK TRACT OR SUBD�VISION t! <br /> DESC. <br /> OWNER AODRESS CITY2IP PHONE <br /> / �/ -] 7 � <br /> ,t��✓ji� ��Ir"i �.! �: ��f I I � %>L, r r•/ �'' 7� fR�=C, �LY- 7J •I-'f'� � l / I 'I <br /> TENANT NAMG CONTACT FOR PERMIT PHONE <br /> �J I / / <br /> ���, �C/ (' G`L(!l /24,� :� r��CyG�d�'�1 E-MAIL I <br /> C NTRA 'T R ✓ ` � , ADDf�E f �� �Z� . P I <br /> �:'� �' o � ��� c S ��-,�'�uJtC✓r,�� l�/�1 � 8 r,� �( l <br /> CONTR.LICENSE M r' Q f ��� �' '�� J �' C�3��) r � � ' �� `� I <br /> f= G' .9i <br /> USE OF BUILDING HEAT SOUP.:E I CONTRACT PRICE OF WORK , <br /> '� �-,�,(,�� . I _EleGric _Gas_.Other <br /> \ <br /> WORK DESCRIPTION <br /> 9 ' <br /> ��� �����-���;� �I-� ��� � i <br /> PLUMBING <br /> MECHANICAL � <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> A/C–air handling unils � <br /> Toilet — I <br /> Bathtub ,_, forced air syslems <br /> _ Lavatory pvash basin) _ Gas piping I <br /> Shower . _ Water heater I <br /> Kitchen sink 8 disposal _ Gas fireptace <br /> Dishwasher _ Gasrange <br /> Clothes washer _ Clolhes dryer <br /> Waler heater _ Range hood <br /> Sink (servicelbadmop/etc.) _ Exhaust fan <br /> Backllow prevenler _ Heal pump <br /> i Urinal _ Unit hea�er <br /> I il _ Drinking Founlain _ Boiler <br /> _ Floordrain Woodsloven <br /> � Grease lrap — p�her <br /> i � Roaf drains — <br /> � ' Olher — <br /> ' .� CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby certify Ihat I have read and examined this application and know the same lo be lrue and correcl All provisions of laws and <br /> ordinances gaierning this�ype of work will be complied with whelher specified herein or not. The grenting of a permit does nol presume <br /> � to give aulhonty to violale or cancel the provision ot any other state or local iaw regulating construclion or the perlormance of <br /> � construction.That I am aulhorized by the owner of�his propeAy to perform the work tor which application is made and I comply wi�h ihe <br /> Sta�e Contrac�ors/Law 1827 RCW and 296200/�(f7 <br /> � via/�C',_�� �(� /�L �/,' l � C/ a1 C' /U <br /> Signature of OwnedContractodAulhor¢ed Agenl Date <br /> - — - - -- -- -- ----- <br /> r <br />