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i - �I j <br /> !, PERMIT APPLICATION � <br /> CITY OF EVERETT PERMIT SERVICES i <br /> 3200 CEDAR STREET, EVEFETT, WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.everettwa.ory ', <br /> APPLICATIONS ARE ACCEPTED FROM S AM TO 4 PM - DFBIT 8 CREDIT CARDS ARE NOT ACCEPTED II <br /> -- �i � <br /> '' SITFi ADDRESS PARCEL TAX I.D.# P�RMIT# � <br /> � q6o� �{o�LY DrZsvE a � � �-i3o �3oo aoo .� �.�3' /1 , <br /> � L6G.�L LOTNO. BLOCK TRACT i I <br /> I DES:L � I <br /> � i OW1iER ADORESS CITY2IP PHONE I I <br /> .•' ' f-I�KSf.��o SLyvoC. DT-.ST. 9V-or syrnLa� Dl=-. Ev��cF,r�-/9Y�.o� �h�- ss6- i�q3 � <br /> ITEN:,NT NAME CONTACT FOR PERMIT PNONE �I <br /> �cNtFt,c,f.,�GEn- E�6ME✓r�n-f'� -r7�-A-�- u-�-uER-w+co Ze6 - �S"'��-- g7�� ' <br /> �I CON"RACTOR S�p�(„='f/C S��j�M1/ ADORESS CITYZP PHONE I I' <br /> f- A-�/s a G �701� R�,�teA..�} �y-vg. M. � <br /> � CON"'R.LICENSE#S���S�GQ'Tw SFh1+�tt�s+•�E, �v11 4�EZ.3 1�6 -S�a- Ss�3� <br /> I ___ 7 V <br /> USI2 OF BUILDING HEAT SOURCE CONTPACT PRICE OF WORK I <br /> E(.f.�'1E?'�T�}'�r SL1�'�oL I _Electric _Gas_Other I A s��3 � . Oa I � <br /> I WOI�:K DESCF;PTION � <br /> r�tQNs c,4-'1'E k� 1.-n�sT7}l.c. �'' x lo' Ssiv�t.f - F7Tt�E NoN- su,.��'� F� � <br /> � <br /> ! ���F�t�-do�YrvO dv6N uN Busc.os.� {�9-S �iA�• f� <br />;;� ;: .� � <br /> PLUMBING MECHANICAL <br />' r,' " P <br /> ,�j�� NO. TYPE OF FIXTURE OR ITEM NO. NPE OF FIXTURE OR ITEM � � <br /> ,{� ` � _ Toilet _ A/C—airhandlingunits I �� <br /> ^ �� Bathtub Forced air sysfems <br />" `�_�� Lavatory(wash basin) � Gas piping <br /> f ""� Shower Water heater <br /> frs � — — <br /> _ Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> � Clothes washer Clothes dryer <br />� � � Laundry trey Range hood <br /> Sink(servicP/bar/mop/etc.) Fxhaust tan <br />�� , = Badcflow preventer = Heat pump I <br /> Urinal Unit heafer <br /> I . _ Dnnking Fountain _ Boiler � <br /> � i _ Floordrain _ Refngerelion I <br /> Grease trap Woodstove <br /> j Roofdrans O!her <br /> Other <br /> � <br /> I <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I I heu:by cerilify that i have read and examined this application and know the same to be We and corred. All provisions of laws and <br /> ''� ordii�aces goveming this type of work will be complied wilh whether specified herein or noL The granCog of a permil does not presuma <br /> to gi.e authonty to violate or cancel the provisio�ef any other state or local law regulaling construction or the pedortnance of <br /> con;rudion.That I am authonzed by the owner of this propeAy to periomi the work for which applicalion is made and I comply with the <br /> Stalr:Contractors Law 78.27 RCW antl 296200 WAC. <br /> � �I r�lD� � <br /> Sigrnture of Owner/ContraC,ur/Authonzed Agent Date �a <br /> — — --—J <br /> I <br /> ��,ati�:��.. . ----------- - - - . I <br />