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PE�cMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES 3� a3--o 6 <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org � � <br /> j'��Y��L -� ? <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PAR:.EL TAX I.D.iF PERMIT# <br /> � ( �, �Q(� �1�/� /�� `(�t i'�� �� ��' —j 4�' <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> PRv �v��Pna�r � cau�urn��v p a. �x �z'3z� � �u�i3 i �`�8 Z <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> Nc�� I �JoKn1 oGoKS�c-I� c.tZs � Z32- t ysZ <br /> CONTRACTOR ADDRE55 CITYIZIP PNONE <br /> CONTR.LICENSEiI PK��I��R� 2o�- <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> r/IULTI y4+'�'��L�1 _Eleciric �Gas_Other n�- ' � —� <br /> � r/� /J / <br /> WORK DESCR�PTION <br /> /l�l_[ ✓ ��u P�r x — FA51' � > �'7'c' �,=�' � <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> L• Toilet A/C—airhandlingunits <br /> �I it Bathtub � � Forced alr systems <br /> 1` Lavatory(wash basin) �_ Gas piping <br /> Shower ��, Walerheater <br /> = Kitchen sink 8 disposal Z,� Gas fireplace <br /> �_ Dish�vasher Gas range <br /> L Clolhes washer � Clolhes dryer <br /> �= ater heater �--�_ Range hood <br /> Sink(service/badmop/etc.) �j 1E�� Exhausl tan <br /> Backflow prevenler _ Heat pump <br /> Urina� Unil hoaler <br /> Drinkinc� Founlain _ Boiler <br /> Floor drain Retrigeralion <br /> � Grease Irap _ Woodslove <br /> �, Rootdr&ins _ Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby cerili(y thal I have read and examined this applicalion and know the same to be lrue and correcl. All provisions ot laws and <br /> ordinaces governing lhis type of work will be comptied with whelhor specifiod herein or noL The granting of a permit does not presume <br /> to givo authonty lo violale or cancel the provisicn of any olher slate or local law regulating consiruction or Ihe performance of <br /> construclion.Thal I am authorized by Ihe owner of lhis properly lo perform lhe�vork for which applicalion is made and I comply wilh the <br /> State C ctors Law 1827 RCW and 296.200 WAC. <br /> � . ._ _ L'17—U�c <br /> � <br /> Signature b�0� od rdra todAulhonzed Agent Date <br /> `l� <br />