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� PL,r2MIT APPLICATI�,�� �ro �L�-�. <br /> � CITY OF EVFRETT PERMIT SERVIGES � � / <br /> � 3200 CEDAR STREET, EVERETT, WA 98201 NC u D `5 ODI� <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> � ) _3U-�j~ <br /> APPLICATIONS ARt ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NU7 ACCEPTED <br /> . SITE ADDRESS /JL)�L E�Y pARCEL TAX I.D.# P�t':MIT# <br /> 1�iG LaN� ��l��t,k '�r� l��/�, -- 04 yG�2yDODv�sco �! �/i' ��/ �/ <br /> LEGAL LOT NO.�'�' BLOCK TRACT <br /> u�sc. �'„5���'e�rrlu^ <br /> OWNER AD�RESS � CIN21Py�jlrl-'^ PHONE3�OGSti(960 <br /> � � <br /> ;Tames ���o��j�:sl`u�nr� ,�)��';� ��J'%%���'/�U%� ������o <br /> TENANT NAME CONTACT FOF PERMIT PHONE <br /> —uN;r��.�z-- - -- - I ��i,�� Nw�a y vzs- s�a -��,�o <br /> CJNTRACTOR � � 1 AD,7RESS CITY/ZIP PHONE <br /> �?q[,Dy LGr�sTtiu< " : , , ����� �,�„ q�t. �:�a, GN, �� .� •65�-�z2t <br /> CONTR.LICENSE# 1T� D L D�I���S � ? �' i ' �� <br /> �� � (�ArY6Vl � . 4�t�. � v <br /> USE OF BUILDING HEAT S�OURCE CONTRACT PRICE OF WORK � <br /> � L�ilh ���?/' �Cl.�q .`� �JC�'.�jc C ---i '�' / >t <br /> I � �� ,_Electric _Gas Olher �/�� c' iv� !U d � <br /> ��,,.,r ---� _ , N , ;��o <br /> I WORKDESCRIPTION ��Un157�ILCJ� Z `C!�/L Cr2/ZpQ? W/L ' %TC,LQ�C RQQlyS <br /> � /u s,�nt •C GQ��Tia.J f!s OLO �q,�l4c -� � y Z C% <br /> I <br /> PLUMBlNG /, ' MECHANICAL �I� I <br /> I / <br /> NO. TYPE OF FIXTURE OR ITEM y r` NO. � NPE OF FIXTURE OR ITEM , • " y` <br /> Toilet _ A/C—airnandlingunits <br /> B3thtub _ Forced air systems <br /> Lavatory (wash basin) _ Gas piping <br /> Shower Waier heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> , Sink(servicelbadmop/etc.) Exhzust fan <br /> � Backilow preventer Heat pump <br /> Urinal Unit heater <br /> I _ Drinking Fountain _ Boiler <br /> � _ Floor drain _ Refrigeratien <br /> I _ Grease trap _ Woodstove <br /> I _ Roof drains _ Other <br /> _ Gther — _ I <br /> � — — <br /> i CiTY OF EVERE'fT LOCAL SALES SAX CODE IS 3105 <br /> ; I hereby ceritify that I have read and examined this application and know the same to be?rue and correct. All provisions of laws and <br /> ' ordinaces guverning this type of svork will be complied with whether spscified here�n or noL The granting of a permit does not pre�ume <br /> ' to give authority to violace or cancel the provision of any othar state or local Iaw regulating construction or the performance oi <br /> � conslruction. That I am authorized by the owner of tnis property to perform the work for which application is made and I comply with the <br /> I State Conhactors Law 18.27 RCW and 296.200 WAC. <br /> � � Il l'f�v � <br /> � Signature o �w erlContra ror/Authonzed Agent Date <br />