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i -- -- . - - ; <br /> ` PEI�MIT ,APPLICATION I <br /> � CiTY OF EVERETT PERMIT SF�RVICES �l� �5"f' � <br /> � � <br /> 3200 CEDAR STREET, EVERETT, WA 98�01 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org �, G����(�Q��J II <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ' \ I <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# �� !,� <br /> � � 2�L,� I <br /> �0� S� ���� �J 2�0 � ��� �� y�� v>� �� S �' <br /> LEGAL LOT N0. BLOCK TRACT ___-- <br /> DESC. <br /> OWNER ADDRESS CINIZIP PHONE , <br /> i��i��� sr ���,��f �� '� t�� �,,;,,,� � �/k 20�r <br /> TENANTNAME CONTACTFORPERM/IT PHONE <br /> �•�/ n�..ss�!/ ��z5 " �7,5 ' 7�'lG i <br /> CONTRACTOR .,Sv;Sr'�� S�J� `' � ADDRESS S� z/ 1 r fr �� S� CI IZIP PHONE � . <br /> � �,� �,,r 9y��� yz�. ��r ,���- <br /> CONTR.LICENSE# �7 V� C -7 ���7 wA•� � � i �. <br /> /� S S�UUC�l7t" � �-� I _� � <br /> USE OF BUILDING HEAT SOURCE /CONTRACT PRICE OF WORK I <br /> � .,��ri� , �� � _Electric _Gas_Olher r�/l�c ci <br /> i <br /> WORK DESCRIPTION / / / � / I <br /> Til s/�`r // G'c1 P �/P�' d � �� N c, .7 �7 (/ / r��"r�f � N � <br /> �'C f'w/c•t_� �J y. r i r: �2 �, �y L'���P.'�`_ S�frqS� <br /> PLUMBIN� MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. '.YPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handling unils <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water healer <br /> Kilchen sink&disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink (service/bar/mop/e?c.) Exhausl fan <br /> � _ Backflow preventer = Heat pump <br /> Urinal Unit healer <br /> '• i _ Drinking Fountain 8oiler <br /> I� I, _ Floor drain _ Refrigeration I <br /> Grease trap Woodstove <br /> � I Roof drains / Other S�c -� - <br /> � _ Other C ,'Ci ,/J. _ � <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> � I I hereby ceritify thal I have read and examined this applicetion and know the same to be true and correct All provisions of laws and <br /> �I ordinaces goveming this type o(work will be complied with whetlier specified herein or not.The granting of a permit does not presume <br /> � to give authority to violale or cancel the provision o(any olher state or local law regulaling construction or the performance of <br /> iconslruction. That I am authorized by the owner of lhis property to perfor the work for which application is made and I compty with the <br /> State-0an ra ors Law RCW znd�96.200 WAC. <br /> i � <br /> ' i i2.i1 ��f��'�� / 2 C� <br /> Siynature of OF4nedConiractor/Auth'orized Agent Date <br /> / / \IZ <br /> I___ _---- — - <br />