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PEr2MIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 5 -01 -o� <br /> 425-257-8810 - FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM P(,(� �L'��.S <br /> SITE ADDRESS 7,y�^ C�� '�� '�f�� PARCEL TA7(I.D.# PERMIT#' / <br /> ;�� f. �,� o< <�� -,� � z c by - oo <br /> LEGAL LOT NO. r. BLOCK TRACT <br /> DESC. / �J//��U <br /> OWNER ADDRESS � C�TYIZIP PHONE360„ 7�'/�7�D <br /> 2G; �r� 9zN�r� �i�_ r.;�> <br /> �{.��' ���- � . , � ^,r_�_� � r �� s�E G-s ,�rl� 5r�h �fi�Nwa�P wH `lBzSz <br /> TENANTNAME CONTACTFORPERMIT PNONE <br /> ' • �-�zic .[��,�r�� `� � yzs"�» �a��- . <br /> .. , , <br /> CONTRACTOR � . � �', , , � ^ ,, �-, � ADDRESS CITY2IP PHONE <br /> r • - , - . .,_ - .. _ , �G`ll4 ��'''A'!� f.r��i . d6���134- P730 <br /> CONTR.LI�ENSE#/ '•.. 1 � . %x : r :L t '�f'i G� �� r^ , . M rj� �.r . . <br /> l�11 �����1� J.7.. �Ci L. J�'�l�^:�rJUr7�� I/J f� � i�i.LrT� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> J('�,_ _Electric �Gas_Olher <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilet A/C—air handling units <br /> � Bathtub / Forced air systems <br /> !i Lavalory(wash basin) � Gas piping <br /> � Shower I Waterheater <br /> i Kitchen sink L .iisposal � Gas Tireplace <br /> ! Dishwashcr Gasrange <br /> i Clothes washer � Clolhes dryer <br /> �_ Wa�er heater / Range hood <br /> Sink(service/badmop/elc.) � Exhausl(an <br /> Backflow preventer Heat pump <br /> Urinal Unit healer <br /> Diinkinc� Foun�ain Boiler <br /> Floor drain Refrigeration <br /> Grease irap Woodslove <br /> Roo(drains Olher <br /> Other � — <br /> _ —I <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritity that I have read an xamined is application and know the same to be lrue and correcL All provisions of laws and <br /> ordinaces govem' this t will br mplied with whether spccified herein or not.The c�renling of a permit does not presume <br /> lo give aulhority 'ola�or cancel Ihe p ision oi any other state or local law reguiating conslruction or the performance oi <br /> construction at am a horiz by owner of this property to perform Ihe work for which applicalion is made and I compty with the <br /> State raclo Law 18 27 RC a� 2�96r.200 WAC. <br /> � � .' L/ �� /�i V / <br /> �l <br /> Signalur OwnedC ntracl"odAulhorize�Agent D <br /> �/ <br />