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P�aMIT RPPLICATIGN <br /> CITY OF EVERETT PERlVIIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.evereltwa.org <br /> APPLICP.TIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE,�R� �������i PARCEL TAX I.D.# PERMIT# <br /> y �� <br /> , � c�-, ��� c� � <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISIOtJ# <br /> OESC. <br /> OWNER ADDRESS CITY/ZIP PHONE�{ <,�--,Z'?��-31 <br /> �,.�, ��,��`� �a�� � ���� A a� a��c I <br /> TENA1NnT NAME CONTA T FOR PERMIT PHONE <br /> � r \ E-MAIL <br /> CONTRACTOR ADDRESS CIN/ZIP PI10NE <br /> CONTR.LICFNSE t! V�/�J �k'� <br /> USE OF BUILDINGS`�(�,.�C �' HEAT SOURCE CONTRACT PRICE OF WORK <br /> ` V �/ <br /> ��5��(,�C.� _Electric f� Gas_Olher <br /> �w t-t <br /> WORK DESrRIPTION <br /> �:i�ti��'k2,. ��-c�'�M e�c��C� ��� � �S� �oo S' <br /> 1'��LIJ�' � ��v�,—i���- �r��v. �Sc2�rv��.�. <br /> �'��C��� ����'R.��U�i� �-c� ^(��sG�1 - TS���S2 c.� �bo 6- � <br /> PLUMBING MECHANICAL ���`..�.� u� <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEhi C wci <br /> Toilel A/C�-air handiing units <br /> Bathlub Forced air systems <br /> _ Lavatory(wash basin) � Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal � Gas fireplace <br /> Dishwasher Gas range <br /> � Clothes washer �L Clothes dryer <br /> Water heater ftange hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat p��mp <br /> Urinal Unit heater <br /> Drinking Founlain . 8oiler <br /> Fluor drain Refrigeration <br /> Grease lrap Woodstove <br /> Roof drains � , -� Other <br /> I er � \ \ �j �. — <br /> CIN OF EVERC-TT LOCAL SALES TAX CODE IS 3705 I <br /> I hereby cerilify that I have read and examined this application and know the same to be irue and correcL All p�ovisions of laws and <br /> ordinaces goveming this type o(work will be complied with whether specified herein or noL The granting of a permit does not presume <br /> to give authority to violate or cancel the provisien of any other state or local law regulating construction or the pedorm�nce of <br /> construction.That I am aulhorized by lhe owner of lhis property to pertorm lhe work(or which application is made and I comply with the <br /> State Con! aclors La� 18.27 RCW and 296.2�WAC. <br /> � �r.Cl `� r ' Vlti� � c��rl �� ` `t ' 0 � <br /> Signalure of Owne/Conlractor/Aulhorized Agenl Dale �� <br /> ,2 <br />