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� �. <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 <br /> SITE ADDRESS PARCEL TAX I.D.p PERMIT A <br /> yU�. I"ni' � ��/�'r ���� C'C� �O ' G� "CUc� J�c�o ��t,�u -o3u <br /> LEGAL LOTNO. BLOCK TR/�CT " � � J / y'� <br /> DESC. � �1 ) 1_ _ 7 ) � {��,�/ I)/ l( C Ci �ll�/' C7L. / /✓. � <br /> OWNER ADDRFSS CITY2IP PHONE <br /> ( �L�7�(..1 ✓C�/1 �l lC,. �i:f,C �` (I'J.i(�J 7.i� 5/j�.� —L��� �/ <br /> TENANT NAME CONTACT FOR PERMR PHONE <br /> �6� /llfi I Js{At �% .7d/l7� <br /> CONTRACTOR� AODRE33 CITY2IP PMONE <br /> �,�� ;�, �� r-„ r���.�c. ; s�r��,�� .; �-,�� �r��y .� �„�,>>,�� ���� - �,�- y���i <br /> CONTR.LICENSE N <br /> �iS.���.� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> r"�' �i��r,t 1 i('---��� k� Electnc Y Gas_Other �3;��, ;-�_ <br /> WORK DESCRIPTION • • � "�, ��/,��/� ' � <br /> � � j'l r,',C t(c-`�,lG�il C S �� j -�tt� �i.�c'��t+cc' � ; %'S�'✓f <br /> o � <br /> (! / �t ���'ilUPl�:liC�1 D'�� icJ:(,Ir/ %�Cd`f"P� `�i�071'i �i'c' c'_, �1� ��c75 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ AIC—air handiing units <br /> Balhlub Forced air systems <br /> Lava�ory(wash basin) _� Gas piping <br /> Shower � Water healer <br /> _ Kilchen sink&disposal �C Gas firepiace <br /> Dishwesher Gasrange <br /> Clolhes washer Clolhes dryer <br /> _ Laundry tray Range hood <br /> Sink(servicelbarlmop/elc.) Exhaust fan <br /> Backflow prevenler Heal pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeralion <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 5105 <br /> I hereby cerilify that I have read and examined this application and know the same to be true and cortect. All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whether specified herein or not.7he granting of a permit does not presume <br /> to give authority to violate or cancel!he provision of any other stale or local law regulating conslruction or Ihe peAormance of <br /> conslruction.That I am aulhorized by the owner of this property to perform Ihe work for which application is made and I comply with the <br /> Slate Conlractors Law 18.27 RCW and 296.200 WAC. <br /> � �i 't-_ _ ��-' r� � <br /> Signaturo of OwnedCo tractodAuthori d Agent / Date <br /> !r.� <br />