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--� , --1 <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ' � — �p -�6 <br /> SI��ADDRESS��1� ^J� C�7�C�y�9 Ol�t- 00 'ERMIT# <br /> �i ��► ' (.�'l�- ae�.. <br /> DESCL LOTNO. BLOCK TRACT�1�� � CJ�Y{�I �l� �i � � <br /> I� -.23 (c �� <br /> OWNER ADDRE55 CITYIZIP PHONE <br /> EJara� -{ir.�F,Skk,^s Qssa t'� 3o�c a-2o3 ��rif{- `��Z13 `-I.Z5-o23`�-�1�1 <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> `�--ti.....� I y�.J�c� �L�. W�a v c.o `�z�.2 3 `( - a�1��7 <br /> CONTRACTOR Q�}�- _ ��u (�I,�r ADDRESS CITY2IP PHONE <br /> CONTR.LICENSE M <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ,�S��K�j� F`r�` _Electric �,Gas_Other <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICP.L <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> ,� Toilet _ NC-airhandlingunits <br /> Bathtub Forced air syslems <br /> ,� Lavatory(wash basinl � Gas piping <br /> Shower _L Wa�er heater <br /> L Kitchen sink 8 disp�sal Gas freplace <br /> � Dishwasher � Gas range <br /> = Clothes washer � Clothes dryer <br /> Laundry lray Range hood <br /> Sink(servicel�arlmop/elc.) Exhaust lan <br /> Backfluw pre�enter Heat pump <br /> �. Unnal Unit heater <br /> Drinking Fountain __ Boiler <br /> .2 Floordrain Refngeration <br /> Grease trep _ 1Noodslnve <br /> Roof drains Other <br /> Olher _ — <br /> CITY OF EVERETT LOCAL SALES TAX COOE IS 7105 <br /> I hereby ceritify that I have rcad and examined this application and knav the same�o be Irue and corred. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or noL The granting o(a permit does nol presume <br /> lo give authoriry to violate or cancel Ihe provision of any other state or local law re9ulating construclion or the pertormance of <br /> construction.That I am authorized by Ihe owner of this property to pertorm lhe work for which applic2tion is made and I comply wilh the <br /> Slale Contractors Law 1�?ZRCW and 296.200 WAC. <br /> �J�A,1w I /\ \ (� — G - � (o <br /> Si9nature ot OwnedCoNractodAulhorized Agenl D.le <br />