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PE�MIT AI'PLICATION <br /> CITY OF EVERE7T PERMIT SERVICES <br /> 3200 CFDAR ST�2EET, EVERETT, WA 98201 <br /> 425-257-8810— FAX�125-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO A PM - DEBIT&CREDIT CARDS ARE NOT ACCER7ED <br /> SITE ADDRESS ��CCX � `_� [ PARCEL TAX I.D.# PERMIT# � <br /> �' � • /' ' iL C: <br /> r�;����cii n.�nuUiia,l, � .� �{� z�� j����r� ��; , ��� ��; „ /,-; : C � <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. :7�� �k rC��ii lL';�/ _ ;;'1 ji�.fi� r '7�j, I�, <br /> OWNGR � ��� A�DRES& _ CITY/LP PHONE � - tjc1V- �J�J <br /> J r.;�- � � .� F F�.� r � r'�_ , : �+ . <br /> � � i � �� :�,-t. ;y;;�lt , - �" rl _ - i ��4� <br /> L'i� L�� 1���;� r � �i�J�l��� 1-,u �- �//r',-. ,� �.? � 7� <br /> TENANT NAME CONTACT FOR PERMIT ' � PHONE �(�j r, <br /> , i �-i�;�,�.1F=�L_ C:{ ; -r �� .'' i � 2`� (::7D li� 7v4' <br /> � <br /> �- l-� '���l�l� �'�-°l�i�-JI {.rn� ��C!�L �J /�Y�, ItJ-...�C.. ,-r (.tl(:= <br /> CONTRACTOR ^ ADDRESS CITY2IP PHONE <br /> _, �-,17 ����� <br /> CONTR.LICENSE 11 <br /> USF.OF 13UILDING (�- � (_'_. I — HEAT SOURCE I `CONTRACT PRICE OF WORK <br /> i) ��-� , <br /> Electnc _Gas_Other -' � � ��`��' <br /> WORKL1ESCRIPTION I ( J�/11._li l �� i(J�'��:t����i��_i_II � 'r.�i„Ji.�� {.l��l�-i���ri�C�'1 � tiJ..'tCJ �.')G'LQPIYIC�'1 <br /> , �!i I `> � c l:'. �- S� /Lc l� 1� '- <br /> PLUMBING ;��., MECHANICAL <br /> NO. 7YPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> FGtchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryer <br /> Laundry t2y _ Range hood <br /> Sink(service/barlmop/etc.) _ Exhaustfan <br /> Backflow preventer __ Heat pump <br /> Unnal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor d2in Re(rigeration <br /> Grease trap _ Woodstove <br /> Roaf dreins Other <br /> ` Olher <br /> I CITY JF EVEREtt LOCAL SALES 7AX CODE IS 3105 <br /> i . — <br /> I hereby ceritify lhat I have reed and examined this,ipplication and know the same to be true and corred. All provisions of laws and <br /> ordinaces goveming this type of work will be complie�i with whether specified herein or wt.The grenting of a permit does not presume <br /> to give adhonty to violale or cancel the provision ef�.ny other slate or local law regulaling construction or the periortnance of <br /> construdicn.That I am authorized by the owner of lhis property to perfortn lhe work for which application is made and I comply wilh the <br /> State Contractors Law 18.27 RCW and 296.200 WAC. <br /> ' ..' <br /> . ." .. .. � . . . . ._ ',,. . , � _ .. - �-� c: <br /> Signature TOwner/ContractodAuthonzed Agent ; Date � <br /> �.___--.--_-.,. <br /> �/� <br />