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P�RMIT APPLICATIGN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STRE[T, EVERETT, WA 98201 <br /> 425-257••8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 9 AM TO 4 PM -DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SI7E ADCRESS / PARCEL TAX I.D.# PERMIT# <br /> /b��� .1��-� �05o�-oz� <br /> LEGA LOTNO. BLOCK TRACT � <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> / � / <br /> 1 (�ZI-!vi i� ` �� t T,./�,ln �f �I/ahe 7� ��S'35���L <br /> �NT NAME CONTACT FOR PERMIT F'HONE <br /> I�'ha r-r�,�rJ �� �� �/�.� ,Po �-�3�:/ G�a:-.�� <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> l�a�� r�1rr,lds}�� <br /> CONTR.LICENSE# �dl��l�h �J�i7� � _3J�:�%�i St -F/�aGa�� �/1J– ?S^7 ( G ,�� . <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF LVORK <br /> Electric Gas Other <br /> WORK DESCRIPTION n / <br /> / � n � I // <br /> �' /I / � /1 — 1 f a S�;,- �_�„ !' �^-+, <br /> R1�-�aGL w i�r�oZv 1l� s d �� �C�-iJ.'�-f' /d2 S /tisY <br /> U � <br /> i� <br /> L'�l'1 0 J I �t?l� <br /> PLUMBING MECHANICAL <br /> NO. TypE OF FI:(TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> _ Toilet A/C–airhandlingunits <br /> _ Bathlub Forced air systems <br /> _ Lavalory(wash basin) Gas pipinc� <br /> _ Shower Walerheater <br /> _ Kitchen sink 8 disposal Gas fireplace <br /> _ Dishwasher Gas r,�nS�e <br /> _ Clothes washer Clo�hes dryer <br /> _ Laundry tray Range hood <br /> � Sink(service/badmop/etc.) Exhaust fan <br /> _� Backilow prevenler Heat pump <br /> _ Urinal Unil heater <br /> _ Drinking Fountain Boiler <br /> _ F�oordrain Refrigeration <br /> _ Grease trap Woodstove <br /> _ Roof drains Other <br /> _ Olher — <br /> CITY OF EVERETT LOCAL SALES SAX CODE IS 3105 <br /> I hereby ceritify that I have read and examined this application and know lhe same to be true and correcl. All provisions of laws and <br /> ordinaces governing this lype of work will bo complied wilh whether specified herein or not.The granting of a permit does not presume <br /> to give aulhority to vio!ate or cancel lhe provision of any other state or local law regulating conslruction or the performance of <br /> construclion.That I am authorized by the owner of this property to perform the work for which application is made and i comUly with the <br /> State Con�ractors Law�27 P.CW and 296.200 WAC. <br /> �� _ <br /> r' � ;; - ., ,. � ��—as� <br /> 9lgnature of Ow dContrAclor Authonzed Agent Date <br /> / <br /> � <br />