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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 96201 <br /> 425-257-8810-FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM a.� �� --�� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT A <br /> ILEGAL LOT NO. BLOCK TRACT OR SUBDIVISION N �' / <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> � �E 1 E P1.GS`�� I r�1.I ti n�vc c FU� G17S-�L-�f� 5227 <br /> TENANT NAME I CONTACT FOR PERMIT PHONE <br /> � •MAIL <br /> ��o Q�{�(7?� CZE�� �j � �_ <br /> CONTR.LICENSE 1t�/�r ,�� GI 2�t 2r� - ��/ � I �� <br /> �Yl.v-t <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> � Electric _Gas Other �h(i�t�, <br /> WORKDESCRIPTION ���� QV[—.2 10j� bF �l5rl'�� S��VI� /-J��IEP. <br /> �;-C;C,F �,<.� Irly 3 �y2 U-�M���/-l7�' S��1A7l�LES. 1N6T/a�� �4�C. iVE�J <br /> � �� <br /> FL/-ISlil��`S � /�I e �'ENf{, ���F T� �3t= il7�llFD (,UITH (�L IVAiLS <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet _ �C-air handling unils <br /> Bathtub _ Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Water heater . <br /> Kilchcn sink&disposal _ Gas fireplace <br /> C��mvasher _ Gas range <br /> Clothes washer _ Clothes dryer <br /> Water heater _ Range hood <br /> Sink(service/bar/mop/etc.) _ Exhausl tan <br /> Backflow prevenler _ Heat pump <br /> Urinal _ U�il heater <br /> Drinking Fountain _ Boiier <br /> Floor drain _ Refrig^ration <br /> Grease trap _ Woodstove <br /> Rool drains _ Other <br /> Other__ — <br /> CITY OF EVERETT LOCAI£4LES TAX CODE IS 7'75 <br /> I liereby certify that I have read�nd examined this applicalion and know lhe same to be true and correct. All provisions of laws and <br /> ordinances governing lhis type oi work will be complied wi�h whether specified here�n or not.The granting of a permil does not presume <br /> to give authority�o violate or cancel ihe provision of any other state or local law regulaling construction or the peAormance of <br /> conslruction. Thal I am authorized by the o�vner ol lhis proparty to peAorm the work for which applicalion is made and I comply with Ihe <br /> Slale Coniractors Law 18.27 RCW and 296.200 WAC. <br /> ��� <br /> • � � • �� !�-{/ ,� <br /> Siynature ol Owner/CoMraclor/Aulhorized Agent <br /> ' a�3 te <br />