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l�ldGrL oG/I„�Ju,y,/S� ; <br /> � ( <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 AftE ACCEPTED FROM 8 AM TO 4 PM �� �,/�-O�j <br /> SITE ADDRESS PARCEL TAX I.D.� PERMIT# <br /> - � :lt � ��-�.,� <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRE55 CITY2IP PHONE <br /> � ,/ /� ,/ <br /> ��t /rl'�'l7 ("'�'r 4 ,f,!�� � <br /> TENANT NAME i� I CONTACT FOR PERMIT PHONE <br /> , �� � <br /> Y/F �•/ �n"1� <br /> CONTRACTOR� 1�-N1tU�N}r.ai[.'F�. ADDRESS CITI2IP PHONE <br /> i7� � Poc� �Dc. �i,Za3 3c�U-�S-�-G..oy <br /> CONTR.LICENSE# Q.I a�n L�T y S 4�� �`�Ni l+, <br /> /v <br /> USE OF BUILDING I — HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Otl�er ' '7�� pv <br /> WORK DESCRIPTION <br /> /(a�„t V N r i iL..-.. I'lu....��nl `� <br /> PLUMBING MECHANICAL <br /> NJ. TYPE OF FlXTURE OR ITEM NO. TYPE OF FIXTURE OR tTEM <br /> � Toilet _ AIC—airhandlingunits <br /> 6athWb Forced air�,yslems <br /> y Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> � Clathes washer _ Clolhes dryer <br /> Laundry tray _ Range hood <br /> Sink(servico/barlmoplolc.) Exhausl tan <br /> Backllow prevenler _ Heat pump <br /> Urinal Unil healer <br /> ,� DrinAing Founlain _ Boiier <br /> Floor drain Re(rigeration <br /> Grease Irap _ Woodstove <br /> Roof drains Olher <br /> Olhor <br /> CITY OF EVERE7T LOCAL SALES TAX CODE IS J105 <br /> I hereby cerilify Ihat I havs read and oxamined Ihis application and know the same to be lruo and cortect. All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whelher spocified herein or not.The grantlng of a pertnit does nol presume <br /> lo give aulhority lo violale or cancel the provislon o(any other state or local law regulating conslruction or Ihe performance ot <br /> construction.That i am aulhor'¢ed by tho owner of lhis property lo parfortn lhe work for which applicatlon is made and I comply wilh the <br /> Slate Conlraclors Law 18.27 RCW and 296.200 W/1C. <br /> Signaturo o(OwnedConlractoqAulhorized Agenl Dale <br />