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PERMIT APPLICATION <br /> CfTY OF EVERETT PERMIT SERVICES , <br /> 3200 CEDAR S7REET, EVERE7T, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM _ I <br /> SITE ADDRES5 PARCEL TAX I.D.# /PERMIT# �//f '� <br /> ���0� K9}�GL4IL- .0 l� lJ�. I IY� L� � �-��7"I <br /> LEGAI. LOT NO. BLOCK TRACT OR SUBDIV{SION Y. <br /> DFSC. <br /> ADDRESS CITY/ZIP PHONE <br /> GWNER �SZUI zo�-Y7S -Z3SG <br /> � ,�� %'r�.v(.'C�,c.� �,i. E7.1Cl�.=T _>�:�� �;`vcti�c� fliJE, �uc�=7T" <br /> TENANTNAME <br /> I CONTACT FOR PERMIT PHONE -- <br /> E•MAIL <br /> CONTRACTOR -y� ADDRESS CITYIZIP PHONE � <br /> ��C�eJ C=y�--� <br /> CONTR.UC�NSE t! i <br /> USE OF 6UILDING � HEAT SOURCE I CONTRACT PRICE OF WORK <br /> I Electric�c Gas_Other <br /> �1 �15TRL� A 7JEw pLRcF a'� Tof� ��""i-, �:_��.t-rc= <br /> WORK DESCRIPTION r�Re 1 <br /> � �,t n,�C� 1i��F�� Fi i�C- Q��tcG �a vu T�P Fi.or'¢ ,�r vi .J� F2u-� � T !_s�•�,�- <br /> i�t( iiJY�LC-" �'Lc.x�i' ww.. , <br /> PL.UMBING MECHANICAL <br /> I <br /> TYPE OF FIXTURE OR ITEM NO. TYPE OF FIxTURE OR ITEM <br /> N0. -- <br /> A/C-air hanAling units <br /> _ Tuilel Forced air systems <br /> _ Bathtub — Gas piping <br /> Lavalory(wash basin) — Waler healer <br /> _ Shower (_� Gas(ireplace <br /> � _ Kitchen sink 8 disposal Gas range <br /> _ Dishwasher Clothes dryer <br /> _ Clothes washer Range hood <br /> Water healer Exhaust fan <br /> _ Sink(service/barlmop/etc.) Heal pump <br /> Back(low preventer Unit heater <br /> _ Urinal goiler <br /> _ Drinking Fountain Re(rigeralion <br /> rloor drain Woodslgve <br /> � Grease trap � Olher - . Z <br /> {, = Roof clrains - I S'.,��� ���� r. <br /> Olher — �,�,« TU�(J FGoc�iZ <br /> I — iv �ti,pDCE FLov�'- <br /> CITY OF EVERETT IOCAL SALES TAX CODE IS 3�05 <br /> I hereby ceriliiy thal I have read and ex2mincd this application and know the same io be true and correct. All provisions of laws and <br /> ordinaces goveming this type ot work w�ll bo complied with whether specified herein or not.The granting of a permit does not presume <br /> to rive aulhorily to violate or cancel lhe provision of any other state or local�aw reyulaling construction or the peAormance of <br /> conslruclion.That I am a t nze by lhe owner of lhis property lo perform the work tor which application is made and I wrnply with lhe <br /> State lraclors Law 8.27 RC a 296.200 WAC. <br /> � ..��- ��-��-� <br /> Signatur o( nedConlractedAul rized Agent Oale �I <br /> I <br /> -- --_—� <br />