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P�Ri11oIIT APPLICA�'It���1 <br /> L�TY OF F_VERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 9Q201 <br /> 425-257-8810- FAX 425-257-8857-www.everetteva.org S '�b""bs <br /> APPLICAT�JNS ARE ACCEPTED FROM 8 AM TO 4 P"A - DEBIT 8 CREDIT Cl.RDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# j� <br /> �--,� <br /> �� Z . —V-eY�G D I D S? _ C- �� "- <br /> LEGAL LOT . BLOCK TRACT <br /> oEsc. r .cn . ?j, -7-hr� Z�_ R�,e. �-(� E. W M <br /> py�q,jcR — pDDRESS CITYILi? �PHONE <br /> }��,� c � ��— s rr�Eue�.��J.,1.L,C 3�l-zs q l.� PI SE r�e r-�1-�- �I-25 �(J (�0 3 D <br /> TEKQNTNAME CONTACTFOR PERMIT PHONE <br /> S�l� > > FArnllu �,u.�-1- .1Q�nsmn �FZS•H�O-Ile30 <br /> CONT ACTOR—� ADDRESS CITY2IP PHONE <br /> CoaS-Iz�l CQnS�l-vu-v{iav; 3yL� �j�t'" � � ! � `(ZS <br /> CONTR.LICENSE# .�J��L�-r ��yH y�ZJ� &�70 –�(��� <br /> � COl�sT('.2G/gc�P� I <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas_Othcr �, <br /> I n�I-� -cn�i I �i — � I 1 D� OOU• <br /> WORK DESCRIPTION ��f�_/ I -- r� <br /> . --i �n � � �, <br /> Cons-��n,u� r.2w 51nyI-� -�1ily Y,esid�v�ce . , <br /> `�;=�' I!:_ , /�-/-.S <br /> PLUMBING MECHANICAI <br /> NO. � TYPE OF FIXTURE OR ITEM NO. NPE OF FIXTURE OR ITEM <br /> � Toilet rJC–air handling units <br /> Bathtub � Forced air systems <br /> � %L Lavalory(�vash basin) �_ Gas piping <br /> � `�;_ Shower _J_, Waler heater <br /> � Kitchen sink&disposal � Gas fireplace <br /> I Dishwasher � Gas range <br /> � Clolhes washer L Cbthes dryer <br /> � Laundry tray Renge hood <br /> Sink(service/bar/rrop/etc.) � Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fo�ntain Boiler <br /> Floor drain � Re(rigeratior <br /> Grease trap _ Woodstove <br /> �� Roof drains _ Olher <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify thal I have read and examined this application and know the same to be true and correcL All provisions of laws and <br /> ordinaces goveming lhis rype ef work will be complied with whether speci5ed herein or nM.The granting of a permit does not presume <br /> to give authonty to violale or cancel lhe provision of any other slate or local law regulating construction or the per(oimance o( <br /> construction.That i am authorized by the owner of this property to perform lhe work for which applicalion is made and I comply wilh the <br /> State Conlractors Law 1 .27 RCW and 296200 WAC. <br /> - ��� 7/'l�ll��t� .� ZOU.� <br /> Signatur o OwnedCo lractor/Aulhorized Agenl Date <br /> I� <br /> ik�y��. <br />