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PERE�IIT APPLICI�TION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 42b-257-8810—FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCFPTED FROM 8 AM TQ 4 PM <br /> SITE ADDR'eSS PARCEL TAX I.D.# PERMIT# <br /> ' o ���f�tf v�1��LL u�o � , c�Sl �'�eya��� �� � ���/.� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> ��l/N��-�' U.1�tLG c� / �GC /�S�// U�Tu✓�t 13ur� ST�Dic� r��r <'6l� /��', <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> 1 �" I�'TI✓�s'S �P_ �)��—�� ,. IM I vl cdc2 ��S- O'�2 /Z�'� <br /> CONTRACTOR �/l���Q`, �(,L,� ADDRESS��s �)�f{�r CITY/21P HONE (f2� <br /> / � TL� <br /> CONTR.LICENSE# �✓��� � �� J2 J(� <br /> s/nv1 � � � �� L�I � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORlt <br /> ��(�� � _Electric _Gas_Other y �(x, v � <br /> WORK DESCRIPTION —7^.�S� L C � =�G(wf �"G�U�.!Kf C � �/ L ��Y��7 ��� <br /> _•` <br /> E�'S7- �Lec/� :�/�5�n LC ([`�..::�..wk�u �l Gau�,�,C_ L7� ��y<< �� <br /> .u�:�7� �L� .�l a,fe w�t�C � . <br /> . : <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling uNts <br /> BathWb Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Snower Water heater <br /> Kitchen sink&disposal Gas freplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> _ Laundry tray Range hood <br /> Sink(service/bar/moplelc.) Exhaustfan <br /> BackFlow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> � Grease trap Woodstove <br /> _ Roof drains _ Other � <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX C7DE IS 3105 <br /> I hereby ceritify that I have read and examined this zpplication and know the same to be true and correct. All provisions of laws and <br /> �rdinaces goverr�ing this type of work will be compliec'with whether specified herein or not.The granting of a permit does not pr=5ume <br /> to give authority to violate or cancel th�provision of an�ottier state or local law regulating construction or the performance of <br /> con ruction.That I am authorized by the owner of this property to pertcTn the work for w�hich application is made and I comply with the <br /> St t Contractors w 18.27 RCW and 296200 WAC. <br /> � - � <br /> Si ature of Owner/ ontractodAulhorized Agent Date �% <br />