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r <br /> PE�IWIT APPLICATION <br /> CITY OF EVER�TT PERMIT SERVICES <br /> 3200 CEDAR STR�FT, EVERETT, WA 982G1 <br /> 425-257-8810—FAX 425•257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �� <br /> ^•� —aC{ — <br /> SITE ADDRESS PARCEL YAX I.D.# PERMI ,Y7Y <br /> 1�1i.5 ' � ' � _ � � � ���1 �) > _--,- <br /> LEGA LOT NO. BLOC�: TRACT OR SUBDIVISION M <br /> DESC. <br /> OWNER ADDRESS CIlY21P PHOPlE <br /> � � c ,.;iz� -�y5 _ <br /> C��'�q lC���cIS��� cic L 1�11� � ack�r,�� I���. �v-er�t�, 18'�1� , .�_-� _ ,.-, <br /> TENAN NAME I CONTACT FOR PERMIT PHONE <br /> I � , L1L.t.) 1����J C� � ��� � <br /> �i�l(\�l �1 '�t�� ����Y � E-MNL <br /> ESS �W N � 1��' <br /> P����cul'S �-leczi�i� )c���-i-� ��Cc,��Ji��(��)���c� �-�e � ''_�D- (���► - 3�J-1 <br /> CON1A.LI ENSF N <br /> (��ri��e?1-�L�Lt�'�'�� C-si�li h . .�i�llg, `1�,�,5,�, <br /> U5�OF BUILDING HEAT SOURCE CUNTRACT PRICE OF WORK <br /> I — f� %/ (:c' <br /> Eleciric V Gas_Olher � / ��� ' <br /> WORK DESCRIPTION ����5 ���f 1�� . ��'�5�1 Ll.l. <br /> PLUMBING hiNCHANICAL <br /> NO. TYPE OF FIxTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet NC–air handling units <br /> Bathlub � Forced air systems <br /> Lavarory(wash basin) �_ Gas pipinc� <br /> Shower __ Water heater <br /> Kitchen sink 8 disposal _ Gas(ireplace <br /> Dishwzsher _ Gas range <br /> Clothes washer Clolhes dryer <br /> Water heater Range hood <br /> Sink(service/b;,r/mop/etc.) _ Exhaust fan <br /> Backflow preventer __ Hcal pump <br /> Urinal Unit heater <br /> Drinking Foun�ain _ Boiler <br /> Floor drain �9elrigeralion <br /> Grease hap _ W'oodstove <br /> Roof drains Oth�r <br /> Olher — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 310'�' <br /> I hereby ceritily lhat I have read and examined this application and know the same to be We and conecL All provisions of laws and <br /> ordinaces governing this type ot work will be complied with whether specilied herein or not.The granting ol a�armit does not presume <br /> to give au�honty to violate or cancel�he provision ol any oUier slate or local law regulating consWc6on or the dedormance of <br /> construction.That I am authorized by the owner ol this pmperty to perform Ihe work for which application is m,�de and I comply wiih tha <br /> State Coniracto�s Law 1827 RCW and 296.200 WAC. <br /> �� �`. a � i�� � 1 �1 fF l �l It� I, � 'l " ��)-�1) <br /> Sgn3tureo C� nedContraclor/AuthonzedlTgent Date <br />