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_ � <br /> PEkMIT APPLICATION <br /> CITY OF EVERET�' PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACC[PTED FROM 8 AM TO 4 PM �(�!rj�)�-�Z <br /> S�IT/E ADDRESS /�' PARCEL TAX I.D.# P R�M�IT# �1 <br /> Y L C_r�!' �n/ic�.l'_� � /tji` ,F'��ilC:d OC'�OSOD "JC.�� L/ �/ <br /> LEGAL LOT NO. BLOCK TRAC�f/ � r � / <br /> DESC.I ��_ iz,U�-�:�2tS -� /�/C�J ��� iC/E �`F" d.�C/Z /Cv/�Z.�N /��L tJ/n <br /> 1 <br /> OWNER ADDRESS CIN21P PHONE � <br /> �[�t.<..'c= /�'��f,�( CNSi �.-�C ��c��tic ..?J= /_J�✓l.�c li/A /�� (.:c�FJ�/I'�`//�' <br /> TENANT hIAME CONTACT FOR PERMIT PHONE <br /> ';91JTRACTOR • AODRESS CITY/ZIP �� PHONE <br /> -�,�:�<- ,2,�����.�•;; ��-� --���•�<-�5��_ �..��..�, ;��: � (/ <br /> CONTR.LICENSE# ' `�"'�'�������y�� <br /> i�� ���cr 9�� .T� _ <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �f;�r `�y„�� _Electric �Gas_Other ��/��� <br /> / <br /> WORK OESCRIPTION <br /> �L L�S �<_ �5� t3 I�/�J �oD �Z�f.ti� S�C . <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FI%TURE OR ITEM NO. TYPE OF fIXTURE OR ITEM <br /> �_ Toilel A/C-air handling units <br /> Bathlub � Forced air systems <br /> � Lavatory(wash 6asin) � Gas pipiny <br /> Shower _ [ Waler heater <br /> Kitchen sink&disposal � Gas fireplace <br /> � Dishwasher �- Gas range <br /> � �ic!hes washer / Clothes dryer <br /> _ Laundry tray � Range hood <br /> _ Sink(service/bar/mop/elc.) ��y1-�_ Exhaust fan <br /> BackOow prevenler / _ Heat pump <br /> . Urinal Unil heater <br /> � Drinking Fountain Boiler <br /> Floor drain Refrigeretion <br /> Grease trap _ Woodstove <br /> Roof dreins Olher <br /> Other_ __ <br /> CIN OF EVERETT LOCAI SALE�TAX CODE IS 3105 <br /> I hereby ceritify thal I have read and examined this application and know tho same to be lrue and correct. All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whether specified herein or noL The granting of a permit does not presume <br /> lo give authority to violate or cancel the provision of any other state or local law regulating consWr,tion or lhe performance of <br /> construction.That I am aulhorized by the owner of this property to pedorm the work(or which application is made and I comply with lhe <br /> State Cc�ntraGors Law 18.27 RCW and 29C,.200 WAC. <br /> ' �F� 9 i� ��^ � <br /> i: �� ��',�. <br /> Signaturo of OwnedContracter/Authorized Agent Dale �/l <br /> , <br />