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. _ . _._ . . _ _ . ---�- - - - - ----� ---- -,i <br /> � PERMIT APP �LICATiON � <br /> � CITY OF EVERETT PERNlIT SERVICES <br /> I <br /> 3200 CECAR STRFET. EVERETT, WA 9$201 <br /> I� 425-257-8810 — FAX 425-257-8857 —www.everettwa.org <br /> I APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ��'L�7 '-�J <br /> SITE ADDRESS PARCEL TAX I.D.# PE IT# I <br /> `ti/ -�. �. y���-�'�T �+���.f��. �;��G� �_\'� ... _. . /'. _f � � <br /> I <br /> LEGAL LOTNO. BLOCK TRACT <br /> I UESC. <br /> OWNER ADDRESS CITY2IP PHONE' �� � � '��� � (��) <br /> �� . ll�- L". �- l <br /> , 'l <br /> ""A1=�C.,(-a��.- �_.,•�^,��1\�."j �i�ll.=,�;.i� . �,i'.(��(`�;�1\ �VP�����P�,—� 4( ���.,tl � �1 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> ��J�:� ;� �i.J ir V r�. �����,�_ .�C.1•,��. � �r-r� C('�. <br /> CONTRACTOR ADORESS ('� CITY2IP PHONE <br /> �� �U � �,f �'� t'1�L..��� <br /> CONTR.LICENSE# �S.�I `L vU� \ ..,�y !,/. ���.�, , �!r> <br /> � \JJ <br /> USE OF BUILDING HEAT SOURCE_� `v/ � CONTRACT PRICE OF WORK <br /> ���` .�,`?�_`r��J I _Eledric _Gas_OlherJ � � "�' /,J�� "� <br /> � <br /> WORK DESCRIPTION <br /> �) � � ,J JS. ., ��`�,'.�.�7 <br /> ,�;_�, 5. <br /> PLUMBING `V �_� MECHANICAL U�� � <br /> NO. TYPE OF FIXTURE OR ITEM � NO. TYPE OF FIxTURE OR ITEM <br /> I Toilet � _ A/C-air handling units - �- <br /> ' — BathWb �� 1�y .�.1-j'�i:_�� �-'L,c^����'.�, _ Forced airsystems �� ` ,��.��� <br /> �I _ ShowerY(wash basin) �'`;,,..(\ `,'�.,C�',� _ Water�hleater -�i�..:1�,�`�..:;�:�•�;_ i���� <br /> � Kitchen sink&disposal � Gas freplace 1 �ll\'-r\ i� <br /> I Dishwasher Gas range <br /> ' Clothes washer Cloth«dryer <br /> � Laundry Iray _ Range ho�: <br /> ��, Sink(servicelbar/mopletc.) Exhaust fan <br /> �� Backflow pieventer _ Heat pump <br /> � Urinal Unit heater <br /> � Drinking Fountain _ Boiler <br /> �j _ Floor drain _ Refrigeration <br /> Grease trap Woodstove <br /> � Roof drains O�her <br /> � Other <br /> I� CITY OF EVERETT LOCAL SALES TAA CODE IS 3105 <br /> I hereby ceritify that I have read and examined ihis application and know the same to be true and correcL All provisions of laws and <br /> � ordinaces governing this type o(work wil!be cnmplied with whether specified herein or not.The granting of a pertnit does not presume <br /> to g�ve aulhority to violate or cancel the provision of any olher state or local law regulating consiruction or the performance of <br /> consVuction That I am authonzed by the owner of this property to perTorm lhe work for which application is made and I comply with ihe <br /> I S�ate�Coniractors Law 1827 RCW and 296200 WAC. <br /> � � � . /, 1 �� � <br /> � ' t . .� / <br /> � _ � 1 <br /> � Sign lure otOwnedContractor/Aulhorized Agent Date �\� I <br /> I / <br /> I ..- -----. .. _.._.__-. ___.— '.� <br />