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PERMIT APPLIGATIUN <br /> CITY OF EVERETT PERMIT SERVICES �,�go�_o G � <br /> 3200 CEDAK STREET, EVERETT, WA 98201 <br /> 425-257-8810– FAX 425-257-8857 –www.everettwa.org �^ /D–Og <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> S-17T�E ADDRESS n PARCEL TAX I.D.ti PERMIT# � <br /> 4.�--� � �'i�'`'����� �-.�}-C-- _��C:' 9t� � - (�C3 <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# ' I <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONF. <br /> �(� ;L�,,� L�i�\�_��7l� ���`�"���� /� lf��lL��'-u�P,b.�i Zi�lnS��.C(� � <br /> TENANT NA CONTACT FOR PERMIT PHONE 7.y ,,,� ��,�-'' <br /> �J� �� p �� ^ n (/�" <br /> C lC/YL'V�" `�, � E-MAIL '"�'�i�V�(� 1 l' �J <br /> CONTRACTOR /_ DDRE ITYIZIP PHO�� <br /> ��'Y`L ����Wt�],(_;1 (��('� �/y�,�lL�� � . �1 <br /> CONTR.LICENSE# �"�'� �" ,��lC�' ��� 1L�Z� <br /> USE OF BUILDING HEP.T SOURCE ONTRACT PFICE JF WQRf: <br /> � � ,C Eleclric Gas_Olher �"�� ���SI�J <br /> LiJ i f��'iF�s�"1 Ct�Q — � , <br /> WORKDESCRIPTION _ �� � � ��,� �,,,}_ Q� <br /> {`,p 111C� �� �Gl ���(,,Vw�LI� �'� �'i1��.�1' ''p�P'� `"'�"' <br /> .,r , . �i, � � �q 1.� 'c�j <br /> v'��,�. ;�{�{ /�i bc��,�TU��a.�� � Lc��1c(��-�. �ra^n d <br /> PLUMBING MECHAPJICAL <br /> NO. TYPE OF FIXTURE OR IT[M NO. TYPE OF FIXTURE OR ITEM <br /> � l"oilel __ A/C-air handling units <br /> Balhtub Forced air systems <br /> � Lavatory (wash basin) ^ Gas piping <br /> Shower 'yv Waterheater <br /> Kitchen sink BSlisp6�al— _ Gas fireplace <br /> � TC Dishwasher _ Gas range <br /> � � Clothes washer _ Clothes dryer <br /> � Water heater Range hood <br /> Sink (service/bar/mop!etc.) � Exhaust fan <br /> Bar,k(low prevenler _ Heat pump <br /> Urinal Unil heater <br /> D���king Fountain _ Boiler <br /> Floor drain ReGigeralion <br /> Grease trap _ Woodstove <br /> � _ Roo(drains _ Other _ <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 I <br /> I hereby cerilify that I have read and examined lhis applicalion and know the same to be true and correct. All provisions o(laws and i <br /> ordinaces goveminc� this type of work will be complied wilh whelher speci(ied herein o. not.The granting of a permit does not presume <br /> to give aulhorily to violate or cancel lhe provision of any other stale or local law rec�ulacing conslruclion or the performance o( <br /> construction. Thal I am aulhorized by the o�vner of ihis property to perform the work for which applicalion is made and I comply wilh Ihe I <br /> State Conlractors Law 18.27 RCW' �nd 29G.200 WAC. � <br /> Signalure `wnedConlractor/ � �or gent � a e � J <br /> C`\� <br /> � -- _ I <br />