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�- PERMIT APPLICATION � <br /> CITY OF EVERETT PERMIT SERVICES i <br /> 3200 CEDAR STREET, EVERETT, WA 98201 I <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SI'!E ADDRESS ���ri!'/=�`-'� •=��1��`'�''�'' PARCEL TAX I.D.# P/E�RMIT# /��(J <br /> �- 5,-'/ L Of!/;r�'1> /}-v'%= �O `% .'` / =�E- G:- C�C` ;"�'�O ��I t %'-i �.J r 3 <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER /�/-,+.)���;C� ,._c,':L'F�'ii�.� ADDRESS CITYIZIP PHONE I <br /> � iac.�i.'G i/ � ;. .�1 LG'�;G/•/;i� !_ /-Cf-'< i�. <br /> TENANT NAME �� ��,��ti���E-L CONTACT FOR PERMIT PHONE <br /> i� <br /> L [ �'i HF.=.�.n/ �GiG��<'�/Y �(��;'-' ��G'/9P%/✓� Gl'� >'���i -,;��y1�• -�j�� <br /> CONTRACTOR �c�"s !��.j/j`i��_C[!i/��PDORESS CITY2IP PHONE <br /> y i SCr� �t/> T ,�n�//�' -o <br /> HG�.�;:r� ;�G -- : ��i <br /> CONTR.LICENSE# �;_5�����.LL ����/(�� /���� �� ���� � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Electric _�Gas_Olher ?� ���7, �'C � <br /> � � �r � C i " <br /> WORKDESCRIPTION �j�y _�.LL �:;�� /-/3y FL.•'.2'i�C <br /> �. � G:.��JLL'!` ���D/2�_ <br /> ( S� C_���//ti�C �-!<�//vLc / f�!���'�i <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub � Forced air systems <br /> Lavatory(wash b�sin) K Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> " Sink(service/barlmop/etc.) � Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal _ Unit heater <br /> Drinkmg Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <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 application and know the same to be true and correct. All provisions of laws and <br /> ordinaces goveming this type of work will 6e complied with whether specified herein or not. The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> constructien. That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> State Contractors Law 1827 RCW and 296.20D WAC. <br /> J � � � = <br /> �.� L '/.'�.L'L.�fl'1L'� S//,'% C`7 <br /> -Signature of OwnerlGontractodAut onzed t 'Date . <br /> --- -- — — — /� <br /> � <br />