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P�RMIT APpLICATION <br /> CITY OF EVERETT PERMIT SERVICFS <br /> 3200 CEDAR STREET, EVERET7, WA 98201 <br /> 425-257-8E 10— FAX 425-257-8857 —www.everettwa.org <br /> APPLICA"i IONS ARE ACCEPTED FROM 8 AM TO 4 PM Q — 6 "� <br /> SITE ADDRESS , / PARCEL TAX I.D.# PE�MIT# <br /> �,�t� � ���ICY�;J) li� ��" <br /> LFGAL LOT NO.` BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> A�,�fa�?r�=�-J �ti��:A-r1��;;�5 .��In ��r����� L��F�i�-r ��.�-�-�'�_�.�`/''ts <br /> TENANT NAME CONTACT FOR PERMIT PHONE��,_��I��_�(r� <br /> ln � �"t <br /> j}�\f"1�: �'\I,UU E-MAIL <br /> CONTRACTOR ADDRE 5 CIN/ZIP PHONE <br /> CONTR.LICENSE# <br /> USE OF BUILDING � I HEAT SOURCE CONTRACT PRICE OF WORK <br /> " ' � ) Electric Gas_Olher <br /> F,<L'��1.�� _fi� 1L - <br /> WORK DESCRIPTION ,, � II� l�!- ��.,v��l�� �,����/ Iti�-I L�.—� � Y��,(�/,� ��� <br /> �/ ��:1�'�' �'1Ci� ��� l-b��" �(if'J � � � +1� <br /> C-�l1�1/'( ( ���-JL�JS � �.:� �/� L�1�'1 I IL���:f" . <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> �alhtub Forced air syslems <br /> Lavatory (wash basin) _ Gas piping <br /> Shower Waler heater <br /> I(itchen sink 8 disposal Gas tireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water heater Ranc�e hood <br />-� Sink(service/bar/mop/elc.) _ Exhaust(an <br /> Back(low preventer _ Heat pump <br /> �' Urinal Unil heater <br /> Drinkin9 Founlain _ Boiler <br /> Floor drain Reirigeralion <br /> Grea,e trap Woodslove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this applica�ion and know lhe same to be true and correcl. All provisions of laws and <br /> ordinaces goveming this lype of work will be complied wilh whether speci(ied herein or not.The granling o(a permit does not presume <br /> lo give aulhoriry to violate or cancel the provision ol any other stale or local law regulating construction or the performance of <br /> conslruction.That I am authorized by lhe owner of lhis property lo perform the work(or which application is made and I comply with the <br /> State Conlractors Law 18�27 RCW and 296.200 WAC. <br /> I._ � ��T'�� A � �-, _ > ������� <br /> Signalure of Owner/Conlraclor/AWhorized Ac�enl DTale <br />