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PEk�UIIT APPLIC;ATION <br /> CITY OF EVERETT PERN�IT SERVICES <br /> 3200 CEDAR STREET, EV[RETT, WA 98201 <br /> 425-257-3810 — FAX 425-257-8857 —www.everattwa.org <br /> APPLICATfONS ARE ACCEPTED FROM B AM TO 4 PM I �'J �- D� <br /> SITE ADDRESS e 4) �� '� � �B PARCEL TAX I.D.# �ERMIT# <br /> �W��i � ���.,c/A�� r����t-f oo�,J73 �r ,Fcti��ru �L'�-12- c�, <br /> LEGAL LOT NO. (� 1B� LOCK TRACT OR�S./UBDIVISION# <br /> DESC. LI .P�I (C Ft L� S I J I� � C�2 L t'11 Ul6. � — <br /> OWNC-R A�URESS CITY/ZIP PHONE <br /> p C.0/+r4'/i p.�(, <br /> ��.1 � ��� l<l��3e.�'/ f-.7f � 1 �''''�y �I KC I:'G7�,��,+'✓�l«� ��/-� '3.�Z)'Z y2� -�'7C� -lfJ 2 <br /> TENANI'NI.ME CONTACT FOR PERMIT PHONE [.,ZS -J=7i. -I1'7 2 <br /> ' / l �f(�2+'c_/7r,�y � <br /> �?✓�ie � ��, 'ZF L.`74 e� E-MAIL l�✓7fh , C e,�'H. <br /> CONTR:ICTQR ADDRESS CITY2IP^ PHONE <br /> �7JR �- 4L'DJ1 '�,r " �f �L� Gc;i�;�r �l.f. �1.� <br /> CONTR. LIC[NSE# <br /> KKG� ��. �,</t; .;��,�% 9�'yYZ �Zr-f=��� - �5�� L <br /> USE OF BUILDING HEAT SOURCE CONTFACT PRICE OF WORK <br /> 2 ����t f �� �I1>f _Eleclric �Gas_Other ���D� L��' �� <br /> V,'ORK�ESCRIPTION <br /> �Ei�i� 2xift ���� Ii� �. �G�-j ��� I,til��� � �� 5� � '-2. <br /> i�L MBING MECHANICAL <br /> NO. TYPE OF FI%TURE Ok ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilet � A/C-air handling units <br /> '1 Bathtub 2 Forced air systems <br /> � Lavatory(�.vash basin) �' Gas piping <br /> �- Shower � Walerhealer <br /> 'Z Kitchen sink 8 disposal � Gas fireplace <br /> 2 Dishwasher 2 Gas range <br /> -T Clolhes washer Clothes dryer <br /> '� Water heater Z Range hood <br /> �i Sink (service/badmop/etc.) _� Exhaustfan <br /> L.` Back(low preventer Q" Heat pump <br /> ET Urinal � Unit heat�r <br /> C Drinking Founlain _� Boiler <br /> � Floor drain � Refrigeration <br /> � Grease trap � Woodstove <br /> ,6' Roof drains Olher <br /> I Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceriti(y lhal I have read and examined this applicalion and know lhe same to be lrue and correcl All provisions ot laws and <br /> ordinaces goveming this type o(work will be complied tivith whelher specified herein or not The granting of a permil does nol presume <br /> lo give authority lo violate or cancel the provision of any olher slale or local law regulating consWction or the performance oi <br /> conslruction.That I am authorized by the owner of this property to perfonn the work for which applicalion is made and I comply with the <br /> Stat�e C�o,ntraclors Law 58.27 RCW and 296200 WAC. <br /> /"�2�/� �'���'�t �c ��-Zcn7 <br /> Signature of OwnedCon raclor/Authorized Agent Date <br /> � � -� <br /> � <br />