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— �� <br /> , <br /> PERMIT APPLICATION <br /> CI`TY OF EVERETT PERMIT SERVlCES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-E810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM -� •-ab -�o <br /> SIT�DDRES�� . �� ����� PARCEL TAX I.D.# PER��T#_ _ ��� <br /> lG�� �D <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> OE5C. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> �G J�a 0.U�( ( �eEvl [-�Y�✓� /���f ��cr5u.�� Ue. Fiie✓e Zd �Z ._3 D <br /> TENANT NAME CONTACT FOR PERM— PHON�v7lJ I ''�!jp0 <br /> ,J�TI�V I� � GmvC. E-MAIL GI�0✓�AUI��I+�/�'�Jl <br /> CONTR CTOR ADDRESS "ITYIZIP HO E <br /> CONTR.LICENSE# O UJ .'�S'�� <br /> USE OF BUILDING HEAT SOURCE CO�TRACT PRICE OF WORK <br /> C'�%� �C,Electric C�Gas_,Other /�" � y7 <br /> WORK DESCRIPTION <br /> �- /��1 .S� <br /> YeG„�de( �'Ivt15� G��'���?� 6A�"�e�i MECHANICAL <br /> PLUMBING <br /> NO. TYPE OF FIXTURE OR ITEM NO. T'PE OF FIXTURE OR ITEM <br /> ( Toilet _ MC—air handling units <br /> -�— Forced air syslems <br /> � Ba�h�ub — <br /> � Lavatory(wash basin) _ Gas piping <br /> Shower _ Waler hea�er <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Z Clothes washer /� Clothes dryer <br /> Water heater / ' Range hood <br />� 2� Sin'. (service/bar/mop/etc.) V"U�'�- � Exhaust fan <br /> 9ackflow prevenler _ Heat pump <br /> Urinal �� _ Unit healer <br /> Drinking Fountain _ Boiier <br /> Floor drain _ Refrigeration <br /> Grease trap _ Woodstove <br /> Roo(drains _ Other <br /> Other — ---- <br /> CITY OF EVERETT LOCFL SALES TAX COOE IS 9105 <br /> I hereby certify that I have read and examined this application and know the sacie to be true and correcl. All pro��isions of laws and <br /> ordinances govemi�ig lhis type of work will be complied wilh whether specified herein or not.The granting of a pertnit does not presume <br /> to give aulhority to vidate or cancel lhe provision of any other slate or local law reydiating consWction or lhe performance of <br /> conslruclion.That I am aulhorized by tfie owner of Ihis property to peAorm the work(or which application is made and I comply with lhe <br /> Slate Conlraclors Law 18.27 RCW and 296.200 WAC. <br /> �'"�-S,l� .c�-,�,�-- -��o <br /> ignature f Owner/CoNractodAuthorized Agen� � /n / <br /> J (/ <br />