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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 y -j O-� 7 <br /> 425-257-8810-FAX 425-257-8857-www.everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �w ����``�� <br /> SITE ADDRESS PARCEL TAX I.D.X ��EnRMIT(�!� 7 <br /> 77:��_ �:I�,.ir,:C. V�'r�" L:' Cl � i�`i'-(GC:4�Cl.�..,"�. "v� (. / � 1 - �� / <br /> LEGAL Ln71�0. BIOCK TRACT 1 J <br /> DESC. � �.1 , `��� i:1 �I�I'IL �UL %I i.�� JCcI- T -w�•3�- V� �LI�. "J fS <br /> ONMER ADDRESS CRY(LP PNONE <br /> �- ..�,..�� .�.1, ...�1 S-'l IS=�1:L l <br /> ��^fl� :. �',-.:`�_i'�I,.:, �l�.l'i i`' ... ., . � '_� t-...,r l. , -C1= '_ ..- � <br /> TENANT NAME I CONTACT FOR PERMIT PNONE <br /> ( i, t " 1°-t' .��=��1 : (.� - �� l -L 77s <br /> ; � <br /> CONTRACTOR >.;����:�_ c ., i_�. '�.�_;' ADDRESS CITYlLP PHONE <br /> CONTR.LICENSEt �� ����; V ;'�°(1,�.�i iJ '. <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> '� k' i� I _Elednc ��Gas_Olher 1�' 1 •-i�%� �-'•-�:- <br /> WORK DESCRIPTION - <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. TYPE Of FIXTURE OR ITEM <br /> � Toilet NC -air handling unils <br /> � BathWb �_ Forced air systems <br /> Lavatory(wdsh basin) � Gas piping <br /> �. Shower Water heater <br /> ! Kitchen sink 8 disposal �, Gas fireplace <br /> � Dishwasher � Gas range <br /> � � Clothes washer _ Clothes dryer <br /> y Laundry tray � Range hood <br /> Sink(servicelbadmopletc.) _ Exhaust fan <br /> � Badcflow preventer _ Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refngeration <br /> Grease trap _ Woodstove <br /> Roof d2ins Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS 9105 <br /> I hereby ceritify thal I have read and examined this application and know Ihe same to be W�aid cortecl All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whether spedfied herein or not.'�he grarrting of a permit dces not presume <br /> to give authority to violate or cancel the provision of any other state or local law reguiating construction or the perfortnance of <br /> construction.That I am authorized by the owner of this property to perform the work(or which application is made and I compty with the <br /> State Conqadors law 18.27 RCW and 296.200 WAC. <br /> , - .j � < , J �; - �- > <br /> Signature of edContraclor/Authonzed Agent Date 1/ <br /> / i � Z <br />