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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES i <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 <br /> SITE ADDRESS -� T PARCEL TAX I.D.N P RMIT A <br /> ///J-!o �M�E F��'� u�y �(i�jl.�.. � I` <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PMONF. I <br /> rv��:�'� K���.Q sriv_ i�,z � c�oGtsrk�.�c �2 Lzu�,��� .z.3 <br /> ��c s2-vc�v_S <br /> I CONTACT FOR PERMIT FHONE� S(o�� <br /> TENANT HAME ���5 L/ L �U 3 7Y � � <br /> ,v_�n/ i2uP�,�;u�v- <br /> CON7RACTOR ADORESS GIIYlZiP PHONE <br /> �U�iNSi�n� �t,vM3n,.,t� �n-� � 933u /1�Fr�F A✓E Nt 4.�227 �36� <br /> CONTR.LILENSEN ./JUn�N��z-�LGL �������" �y 7�� Z <br /> /�- r� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas_Other �-36�� <br /> S r=iQ.. — — <br /> i WORK DESCRIPTION <br /> ��✓STAu r-,�� .S �21NK�� SYSiZ� ��"Y� r/�PA- /3� <br /> i..� N� S y2 <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE UR ITEM <br /> NO. TYPE OF FIXTURE OR ITEM <br /> A/C—air handGng uNts <br /> Toilet Forced ah systems <br /> Bathtub Gas piping <br /> Lavatory(wash basm) Water heater � <br /> _ Shower Gas fireplace <br /> _ Kitchen sink&disposal Gas range <br /> Dishwasher Clothes dryer <br /> _ Clothes washer Range hood <br /> Laundry tray Exhaust fan <br /> _ Slnk(serviceroadmopletc.) Heat pump <br /> BackAow preventer Unit healer <br /> _ Unnal goiler <br /> __ Dnnkmg Founlain Refngeratwn <br /> Floor drain Woodstove <br /> _ Grease trap Other <br /> _ Roof dreins �� <,Oo_ii..�K t�-�7P— f1'B'�.�-S <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceritiry that I have read and examined this appllca6on and know the same to be true and correct. All provisions of laws and <br /> ordmaces govemmg this rype of work will be complied with whether specified herein or noL The granting ot a permit does nol presume <br /> ;o give authority to violafe or cancel the provision o1 any other stale or local law regula6ng construc4on or lhe peAormance of <br /> construction. That I am authonzed by the owner of this property lo pertorm the work for which appliwtion is made and I comply with the <br /> State Coniractors Law 18.27 RCW and�2Q0 WAC. <br /> I�i I I ��� � �/; �%��� <br /> Signatu of Ownerl onlractorl uthon ed Agent Date <br /> i <br /> � j <br />