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PtRMIT APPLICATIC�N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA�38201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.oig <br /> APPLICATIOMS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PE�tM1T A (� <br /> � �,��,p r-� �— <br /> LEGA LOT NO. BLOCK TRACT OR SUBDIVISION k <br /> � DESC. _ <br /> OWNER ADDRESS CITYlLIP PHONE <br /> �C i'l I I�C�t�`c 1� �� C' � �%'S-.�5�1'e2`(�f� <br /> � /�v G��� /-1,� � ,,.�e�/ 9��I <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> J[tr1T ��.�G��P � ��f,t�cA S�IV'iCtl � _� �-rJ �e�SU <br /> , 5 /J S U— <br /> r <br /> CONTRACTOR S��vor S@�✓i��S o{ ADDRESS GTY21P PHONE <br /> o�as yy� ,G��, �✓ p � ya5 <br /> 5rci.U�isl� C�c,_...�-r A " 1 ,�50-IaSU <br /> CONTR.LICENSEp �r'ICdFi'1fC �I�S�7� <br /> 5�/�l tO5�ay3nH s�,jc 0 _ <br /> USE OF BUILDING I HEAT SOURCE CONTRACT PRICE OF WORK <br /> � f _Eleclric �_Gas_Olher c_l�'�'� <br /> �a'�( r <br /> WpORK DESCRIPTION <br /> Y.!�mJ/{ {�S�S���S Ub��Pr ��Pc.�rr ���nc•� is l�c.��rt7 <br /> Rt��C,.l[ cnJ��i �.� v+lv� (nla�rl (�p,.,��iY <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXiURE OR ITEM <br /> Toilet _ NC-air handling unil; <br /> Balhtub _ Forced air syslems <br /> Lavalory(wash basin) Gas piping <br /> Shower � Water healer <br /> Kilchen sink 8 disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clothes washer _ Clothes dyzr <br /> Water healer _ Range'iood <br /> Sink(service/badmop/etc.) _ Cxhaust fa� <br /> �ackflow preventer _ Heat pump <br /> Urinal _ Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain _ Refrigeration <br /> Grease trap __ Woodstove <br /> Roof drains _ ��her <br /> Olher — -- <br /> — <br /> — — -- � <br /> CITY OF EVERETf IOCAI SALES TAX CODE 15�105 I <br /> I hereby ceritify that I have read and examined this applicalion and know the same`o be true and correct. All provisions of laws and � <br /> ordinaces goveming this type of work will be complied with wheiher specified hereir or nol.The granting oi a pertnit does not presume <br /> lo give authority to violale or cancel the provision of any other state ui local law reg�latiny canstruction or the perfortnance of <br /> construction.That I am aulhorized by the owner of ihis property to perform Ihe work for v:hich application is made and I comply with lhe <br /> Slat�Contractors Law�a6.27 W d 296.200 WAC. <br /> � % <br /> ���'/ �� � ���_ .�� � — <br /> Si �(ufe� Owned ontraclodAulhonzedAgenl Date <br /> ,� ,i ( � <br />