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PERMIT APPLICATION <br /> CITY OF EV�RETT 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 8 AM TO 4 PM <br /> SITE ADDRESS �PARCEL TAX I.D.# I PEkMIT# � <br /> l31c /�r�s � �zao�oz-c.n4-o24-00 � L�o� - � ', <br /> LEG LOTNO. BLOCK TRACT <br /> oesc. TRx> F �frr C��r� LorB <br /> WNE4 ADDR SS ITY/ZIP PHONE <br /> q.�:qrrbN, D�v �.oP,v�uf /� 40o H�z r3i �� <br /> �H#' 2G6-Z�B--o2�"L �s�-Tr� �'��i�� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �e ����/�� .206-325-2553 <br /> CONTRACTOR AD�RESS CITYILP PHONE <br /> �i-/�E.wr Ccws�e..af�o,� 6650 5W�Enwo cw� Lt}Nb �t370 - �3-3��Y9� <br /> �QNTRrLICENSE � P�izTL�g�t� , O2E '�722�- <br /> � -� �; - �c� , PA�vaT�i9�Wr�. <br /> �SEOF�HOILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �"�9'���E I _Electnc ,�,Gas_Other I �� �Lri� G'bQ <br /> WORK�ESCRIPTION � ������ �, �p� �a SP/�/.C./KLEb �G+-��, <br /> Cos�Sf�v�'Lcu OF SHE <br /> o� A�� � �}7, 50o S� A�n HssauflTt7� .SiTt >✓auc-. <br /> PLUMBING MECHADlICAL <br /> NO, IYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air hai�dling units <br /> Bathtub forced air sys:ems <br /> _ Lavatory(wash 6asin) � Gas piping <br /> _ Shower �' . ;��/ lt.+,' �� i�..• ,� '_ .. — Water heater <br /> _ Kitchen sink&disposal J� O— '� ��c;�:� Gas fireplace <br /> Dishwasher Z��' � }`� '` Gas range <br /> Clothes washer ' �'7 Clolhes dryer <br /> Laundry Iray ��"1 U�t-�hrnC (T�_ r✓ — Range hoad <br /> _ Sink(service/6admop/etc.) ,�. „ � ,, Exhaust(an <br /> _ Backflow preventer ��''�� ` '� �-�' �' � � Heat pump <br /> Unnal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Rafrigeratlon <br /> Grease trap Woodstave <br /> Raa(d2ins ONer <br /> Other <br /> � CITY OF EVERtTT LOCAL SALES TAX COOE IS NOS <br /> I hereb/ceriti(y ihat I have read and examined Ihis applicatlon and know the same to be We and cortect PJI pmvisions of laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or noL The granting of a pertnit does not presume <br /> to give authoriry to violate or cancel the provision of any other state or local law regulatlng cunsWction or ths pedormance of <br /> constructio . ha!I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> Stat Cont rs Law 18.27 RCW ard 296.200 WAC. <br /> —�— � i1� � <br /> Si naWre of Owner/ConVactorlAuthonzed Agent Oate t ' ' <br /> � <br />