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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETI�, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � � � ���(, <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> = �:2 l C �- c�l .�� �7 �O(� - ��2 <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> ��w,n�on z L�� ���1 Lrrr,}��rd l�u� L�. v�"1I Lr�S- 25a"��I2 <br /> ,,� ( 1"k�,��t CG u rc 1,, e( <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> E-MAIL <br /> CONTRACTOR ADDRESS CITYIZIP PH NE <br /> /�� � ted. �cxs�r��c�r� rnc. pp. gc�( yU! woc�rn�i[(Q , �-'�• S�C�72 <br /> CONTR.LICENSE# <br /> � L� tFcs ( 31 C /� y �5'f��9- ?�� 3 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �r. <br /> ��,U y-t_h, _Eleclric _Gas_.Other -.� �( � ��� <br /> WORK DESCRIPTION <br /> �evv�ov� Sha � �o��} . ,1 o,S�c•.� � (.9s fs' 5h�.9=�tve,S- i C'- « W— <br /> �r J <br /> 4lew t��'�� �C�i' <br /> PLUMBING MECHANICAL <br /> NO. TYP[OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bath�ub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Waler healer <br /> Kilchen sink&disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clolhes washer Clothes dryer <br /> Water healer Range hood <br /> Sink (service/barlmop/etc.) Exhaust fan <br /> Backflow prevenler Heat pump <br /> Urinal Unit hea±er <br /> Drinking Founlain Boiler <br /> Floor drain Re(rigeration <br /> Grease trap Woodstove <br /> Roof drains Otl.er <br /> Other _ <br /> i CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby certify that I have read and examined lhis application and know lhe same to be irue and correcl. All provisions of laws and <br /> ordinances governing this lype of work will be complied with whether specified herein or not.The granling of a permit does nol presume <br /> to give aulhority to violate or cancel the provision of any other state or local law regulaling conslruction or ihe performance of <br /> construction. That I am authorized by lhe owner of this property lo perform lhe work for which application is made and I comply with the <br /> Slate C trzclors Law 1 .27 RCW and 256200 WAC. <br /> �a.. ��o� � - f 8 "'lo <br /> Sig a re of Owner/C Nracl /Autharized Agent Date <br />