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P�RMIT APPLICATION <br /> CITY OF EVERf.:TT PEFtMIT �CRVICES <br /> 3200 CEDAR STREE i, EVERETT, W.4 982�1 <br /> 425-257-8810- FAX 425-257-8857 -www.everettwa.org <br /> � <br /> AI'PLICATIONS ARE ACCEPTED FROM 8 AM 'f0 4 PM 3 '�� � <br /> SITE ADDRESS � �, ; PARCEL TAX I.D.# PERMIT# <br /> i <br /> ' f`-,� :� fr���-; � .,� ,:�'�c� ��-2 3ac�<<�/ i? ' D o�0 7-ov <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. t - <br /> I OWNER ADDRESS CINIZIP PHONE <br /> ] l �. � ���_� �... � iZ—i�� l4tr��z�' �lL' <br /> ��l(-C. �J1 i' � �/ �U � . � ?.-r-� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> CONTRACTGR � ADDRESS CITY/ZIP PHONE <br /> � z e n�y S � � �. (<< , .� ��ZJ - I <br /> =�'-(.01��C- LC�, l2?l6 S. Lrcs= 7t.-c.._ <br /> CONTR.LICENSE# `�� �_��.L L-A 1< < Sf L�'"5 �'J�"�" ��c7� S� �'-� ii�3 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> .[.�� ��C. _Y � <br /> �:. s,��(.��-/��h� _Electric _Gas._Other <br /> WORK DESCRIPTION <br /> �,� <br /> , <br /> -��t�_: <br /> PLUMBIIJG MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE GR ITEM <br /> Toilet _ A/C-air handling units <br /> Bathtub _ Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Walerhe2ler <br /> Kilchen sink 8 disposal _ Gas fireplace <br /> Dishwasher _ Gasran9e <br /> Clothes washer _ Clothes dryer <br /> Waler heater _ Range hood <br /> Sink(service/badmop/elc.) _ Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal _ Unit healer <br /> Drinking Founlain _ Boiler <br /> Floordrain _ Refrigeralion <br /> ' Grease trap _ Woods v _/ <br /> II Roofdrains �� Other - ��r ��� - ✓ <br /> s• <br /> Other — <br /> 1 CITY OF EVERETT LOCI\L SALES T;J(CO�E IS 3105 <br /> I hereby ceritify that I have read and ezamined this application and know lhe same lo be lrue and correc.t. All provisions ef laws and <br /> ordinaces 9oveming this lype of work will be complied v+ifh whelher specified herein or not.The granting o(a permit does not presume <br /> to give aulhoriry to violate or cancel lhe provision of any othei slate or local law re�ulatinc�consWction or the pedormance of <br /> conslruclion.That I am authorized by the owner of Ihis property to periorm the vmrk(or which application:s made and I comply with the <br /> Slate Conlracfors Law 18.27 RCW and 2�6200 WAC. / <br /> � � - �- _ 5'�j ��� � <br /> Signalure of Owner/Contractor/Authonzed Agent �9ate <br /> � <br />