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- - --- - -- - — - ---- - -- - _ - <br /> � - ---- ----- <br /> PERMiT APPLICQTION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVEREI"1, WA 98201 <br /> � 425-257-8810— FAX 425-257-8857 —�vww.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> �. SITE ADDRESS �� PARCEL TAX I.D. # PERMIT N <br /> ; Z �Gt��� ��/�e�p o(Q oovD�goo C loo�- o!�a. <br /> LEGA LOT NO. BLOCK TRACT OR SUO�IVISION# <br /> ��ES�1 � S � d� — v�� <br /> OWNER ADORESS CITY/ZIP PHON[ <br /> � �_���_�1�:�,v� ��n SI � �1 z z P�c� p� �rZs 37v lyi <br /> I TENANT�JAME I �ONTACTFORPERidIT PHONE /��S– 8-j(� C,C�lL <br /> '/ / �{ <br /> I I I l�fiv ' V/l-�✓ �L`�LCl� E-M17AILVliI✓Is� <br /> ���_� � <br /> ' CONTRACTOR ADDR[55 � CITYIZIP PHONE ��l���Z� �G+�. <br /> U�IIJ SLYG�< ✓�SSOC f�. �OX 13 DG G �v�'/et� �f�pD<o � � <br /> CONTR.LICFNSE k y ZT ��y 9y�Z � <br /> i _ U�vs�?LLb o _ <br /> I USE OF BUILDING HEA'f SOURCE CONTRACT PRICE OF WORK <br /> � �F�� _ Flectric ' \Gas_Olher z 2�� ��U <br /> WORK DESCRIPTION <br /> i �� f�-� z��� �� <br /> � PLUMBING ��G� MECHANICAL <br /> �i NO. TYPE OF FIXTURE OR ITEIA NO. TYPE OF FI%TURE OR ITEM <br /> jL� Toitet �� i A/G–air ha�di.�ng unds <br /> r Ba�htub I I Forced air systems <br /> i � Lavatory pvash basin) 1 I �,1 � Gas piping <br /> � Shcwer I � Water heater <br /> L Kdchen sink 8 dispasal _�_ Gas fi�epiace <br /> � � Dishwasher _�, Gasran9�� <br /> � Clo!heswasher 1 Clo�hesdiy._� <br /> _�_ `Plater heater Ranye hcod <br /> i Sink (servicMbadmop/etc.) / `P�U�'��� �_ Gxhausifan !�'I./ <br /> I . � Hackflow preventer �' _ I{cat pump <br /> Unnal Umt heatcr <br /> Diinkin9 fountain _ L'o�ler <br /> floor drain Retngeration <br /> Greasc Irap Woodstove <br /> Roof drains Othcr �_ ___ <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS]105 <br /> I hereby ceridy Ihal I have read and examined Ihis apphcation and knov+the same to be Irue and correcl. Ail pwvisions of laws and <br /> oidinances governing Ihis lype of work w�ll be eomplied wdh whe1L•er spenfied herein or not The granting ol a permd does not presume <br /> to give aulhority to viclate or ca cel the provision o(any olher slale or local lavi regulating conslmction or Ihe per(ormance of <br /> consl�uction. That I am th zed by the owner of Ihis property to per(orm Ihe work(or which application is made and I comply v�ith the <br /> Slatc Coqir etiors La 1B: RCW and 2962004VAC. <br /> j,�� � 7-/ /O <br /> S�griature of OwnedContractor/Authonzed Agenl Dale \I� <br /> �-- ---- — ------ --- --- ------ ------ — _.— <br />