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PCRMIT APPLICATI(��� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM �� a --0� <br /> SITE ADDRESS PARCEL TAX I.D.# ['ERMIT# <br /> 1 �. "v��� o <br /> 3 " OZZ � �> °(03 - 3L, <br /> I LE3r:� LQT N . BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> Te �=F R;-�r l5u l�o,�� ��_r�rl wr4- vz5� zal - yza8 <br /> TENAN7 NAME CONTACT FOR PERMIT PHONE <br /> (�/a,nt/Gl� ',Jr.r�lrt� E-MAIL yL5 - 35 I ' �767Z' <br /> CONTRACT R ADDRESS ✓— CIT\'�P PHG4E <br /> c1 l ya5-35`l-(��yL <br /> CONTR.LICEIISE N���� _ 5 ,U ' o�' � <br /> /, A ��rl{, t'i � 4zZ1 s�� 530 �tir I�r�;��Fo�• v�� 9f1u5 <br /> USE OF BUII_DING HEAT SOURCE CONTRACT PRICE OF WORK <br /> C't,rke}r I —Eleclric _Gas_Other J1 j�� ' <br /> WORK DESCRIP710N <br /> . �;y -{�c�n�/af-ron , Rcro�fr scuCr �'F n�ecc. ss«r�/ . <br /> ��'��� n 1 �.�gxZG � <br /> �('�f��r�,r� /�cr�c.c c.ni5'�'In� c•r� .,e WG�.�I on /Ic/'f�^ f�[�c of' �^o� sr ��n[IYc�G(C <br /> 1� <br /> �-- PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ A/C-air handling unils � <br /> Bathlub __ Forced air systems I <br /> Lavatory(wash basin) Gas piping <br /> Sho�ver _ Walerheater � <br /> Ki�chen sink 8 disposal __ Gas(ireplace <br /> Dishwashcr Gas ranye I <br /> Clolhes washer Clo�hes dryer <br /> Waler healer Range hood <br /> Sink(servicelbar/n:.:p/elc.) _ Exhaust(an <br /> � 6ackflow preventer Heal pump il <br /> �� Urinal _ Unit healcr <br /> _ Drinking Fountain Boiler <br /> Floor drain Refrigeralion I <br /> Grease lrap _ Woodslovo <br /> Roof drains Olher <br /> O�her <br /> CITY OF EVERETT LOCAL SALES 7'AX CODE IS 3105 <br /> II hereby cerilify thal I have read and examined this applicalion and know Ihe same lo he true and correct. All provisions o(laws and I <br /> �, ordinar,es governing lhis lype o(worh will be complied wilh whelher speci(ied herein or noL The grenling of a permil does not presume <br /> to give aulhori;y lo violate or cancel the provision o(any olher stale or local law regulaling construction or the pertormance of � <br />� ' conslruction. Tha� I am aulhorized by Uie owner o(lhis praperty lo per(orm Ihe work(or which application is made and I compty wilh the I <br /> , Slale Conlrac;ors Law iH27 RCW and 29u.200 WAC. i <br /> I � � <br /> 1;;� __ 3 — 1-cxl <br /> �'' Signalure ol Owned on actodAulhorized Agent Date �/ <br /> � <br />