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i --- — --- <br /> ;PE`. .MIT APPLICATIOi� <br /> CI�Y OF EVERETT PERMIT SERVIC�S <br /> 3200 CFDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ?� -C{ —/� <br /> SITE/ADDRESS PARCEL TAX I,D.# �P�E/�MIT# <br /> (O ��a D� m iC. �l,✓P �Y� � ��310D � <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> OESC <br /> OWNER ADDRESS CITYI2IP PHONE <br /> (,/ G b ly.rip�c. 6w� El/C.�e--c4- w� <br /> fENANT NAME I CONTAC FOR PERMIT PHONE <br /> I E•MAII <br /> (:ONTRACTORP����CK n'�+-wGfD�S 'QDDRESS �pp gpK ZS �qi CITYIZIP PHONE <br /> l �i�G��?n0 Wr�- <br /> CONTR. LICENSE# <br /> �IGCNCS /oi ,.�a Zs34o,��8�1� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK ��. <br /> 4 <br /> `���%� ���� _Eleciric � Gas_Othar /. O U O i <br /> WORK DESCRIPTIO i <br /> ' I <br /> i <br /> � <br /> i <br /> PLUMBING MECHANICAL � <br /> NO. TYPE OF FIXTURE OR ITEM NO. , .TYPE OF FIXTURE OR ITEM <br /> _ Toilet A/C-air handling units <br /> __ Bathtub Forced air sys�ems i <br /> Lavatory (wash basin) J_ Gas piping <br /> _ Shnwer Water heater I <br /> Kitchen sink & disposal Gas freplace . . _ <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer � <br /> Water healer Range hood <br /> Sink (service/6admop/elc.) Exhaust(an <br /> Backflow prevenler Heat pump <br /> Urinal Unit heater � <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeralion � <br /> Grease�rap Woodstove <br /> Roof drains OL;er <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 71�5 <br /> I hereby cerii(y Ihat I have read and examined ihis applicalion and know the same lo be true and correcl. All provisions of laws and <br /> ordinances goveming this type of work will be complied with whether specified herein or noL The granting of a permit does nol presume <br /> to give authority to viola!e or cancel Ihe provision o(any other state or local law regulating construclion or the perfor�nance of <br /> conslruction. ?hat I am authorized by the owner of this property to peAorm the work for which application is made and I comply with Ihe <br /> Slate Conlraetors Law 18.27 RCW and 296200 WAC. <br /> �c.�'Nr�/ -- �'�c/�tc .3-4-.o I <br /> Signa Ure of OwnedConiractodAulhorizeC Agent Date <br /> I— ---- -- -- — I <br />