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--- —� — <br /> ' PERNtlT APPLI�AT��P� <br /> CITZ° OF El�ERETT PERN�iT �ERVICES I <br /> 3200 CEDAR STREET, EVERE7T, WA 98201 I `'-'-�CI"�S <br /> 425-257-8810-FAX 425-257-8857-wvnv.everethva.org <br /> Y ' -�, � <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM , �A� � v� - C��L� <br /> SfTE ADDRESS PARCEL TAX I.D.# PFRMIT q <br /> /' <br /> �i� i �� I II � (b'(l,l.l � �;�i � 2. ^�1 `' � �-�j(�—r <br /> IEGAL LOT NO; BLO/�Cit T�gJ ACT I <br /> DESC. ,� E i � 1,I ' I" ( " �, _ i' �(.n - - <br /> OWNER AD�RESS CINfZIP PHONE I <br /> ''� �;if�hl(��oit� �n�.��fmonf�, l.l C P G. R!�x I�� )-,'�rli n�tr`n, Gy�/� `1,�2�� �125-�1.��151c% <br /> TEtJANTNAhTE CO!fTACTFORPERMIT �� PNONE i <br /> N�R � �enni� V�I`riqleS�.u�Y�f h y�5-3�.�-45L�2- I <br /> CUNTRACTOR�GI��U�C�S�L� NDl l lk'��DDRESS ' CITYlZJP PHONE � <br /> � CONTR.LICENSE� �(�RI �C� IOt�C J �V• �OX I����1 �� ��U����'7�1� ������� "E������� <br /> Iv <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _�In �( �—/i M� � ' �5�� i _Eledric ,�,Gas_Other � � ' 1 <br /> I ! lU � l <br /> WORKQE CRIPTION l_ ��'°% : — ; <br /> T <br /> 't, Z� ✓ <br /> �-� 1�'�Z�.f �rc�n� �;i«c��. �tlm i�� �s i c�n c� <br /> PLUMBING MECHANICAL II <br /> NO. - TYPE OF FlX7URE OR�TEL7 NO. TYPE OF Fll(TURE OR ITEM11 i <br /> � Toilel � AIC—air handling units <br /> Bathtub ' � Forced air systems <br /> Lavatory(wash basin) / ,,4. Gas piping <br /> Shower, � Waterheater �. <br /> T Kitchen sink&disposal Gas fireplace I <br /> � Dishwasher Gas range <br /> � Clothes washer T Clothes dryer <br /> _ l.aundry hay � R2nge hood <br /> Sink(servicelbadmop/etc.) Exhaust fan . . _. <br /> _ Backfloer preventer _ Heat pump <br /> ,i __ Urinal _ Unit heater I <br /> �rinking Fountain _ Boiler <br /> Flour drain Rehigeration <br /> Grease trap _ Woodsiove <br /> ' Roof drains Other <br /> OUier <br /> — -- i <br /> I CITY OF EVERETT LOCAI SALES TAX CODE IS 1105 I <br /> I <br /> I hereby ceritify that I have read and examined ihis application and know the same to be true and correct All provisions of laws and <br /> ordinaces goveming this type of�rork�vill lm complied e�ith whether specified herein or net.The o�anting of a pertnit does not presume <br /> to give authority to violate or cancel the provision of any other state or Iocai law regulating construction or the performance of <br /> consWction.That I am authorized by lhe o�vner oF;his property to pedorm lhe erork for which application is made and I compty wilh the <br /> State Con�tactors Law�18,2i R � a d 9"0200 WA,; I <br /> � _ �� . , ". ��� � <br /> Sig�ature at Owrter o ctot �thor ie AgenY ate i <br /> L--- - ----- ----- - `y�� <br /> � <br />