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PERMIT A�PLICATION <br /> CITY OF EVERE'iT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 38201 <br /> 425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ({ ..�J �Q�j <br /> SITE ADDRESS PARCEL TAX I.D.N PE�MIT N <br /> � � �C ' �Vl-� i.�: �; `7[�"J �iJli��>-G'�� <br /> IEGAL lOTNO. BLOCK TRACT <br /> D[SC. <br /> ONMER ADDRESS CITY/ZIP PHONE <br /> 1 <br /> �i�2j� �'1/it�����1'� 1�-1�f i(Cf�i����l�CTl� <br /> TENANT AME CONTA T Fq R PERMIT /� PMONE <br /> �b.Y ��!i=.��son /r��2'/JiTu� Z�i 2�G ��'✓�� <br /> A��,,� ci�;,� �� <br /> CONTRACTOR ADDRE35 CIN/LP PHONE <br /> �{f,h��/ C,�,���n���i�.� A��� ���2�7 ��IG��G ��o/ C`�zs��s`I-/�o�r i <br /> I C HTR.LICENSE M �-. i � <br /> h�%i��fi-�Dr � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> vr /,� v <br /> /'�G� _Electric _Gas_Other �/'/ a��Q _ <br /> /",/ <br /> WORK DESCRIPTION <br /> l'a���,/,v�:�jvr � �>�s.�,rzerr� �'�';��,{�iii5 �I� rr��rr„-�a ��. <br /> C;;;z� ��� Frf��if �'i,e. ��e��z�'��'��� <br /> � <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forred alr systems <br /> Lavatory;�.cssh basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> � �ishwasher Gasrange <br /> Cbthes washer Clothes dryer <br /> Laundry tray Ranye hood <br /> Smk(servicelbar/mopletc.) Exhaust fan <br /> Backflow preveMer Heal pump <br /> Urinal Unil heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Other __ <br /> CITY OF EVERETT LO�dL SALES TAX CODE IS 3105 <br /> I hereby centiFy that I h_ie read and examined this application and kncw the same to be true and corted. All provislons of laws and <br /> ordinaces goveming this rype of work will be complied with whether spe;.ifed herem or not.The granting of a permlt does not presume <br /> to give auth - viola:e or cancel the provislon of airy other state or lor,�l law regulating wnstruction or tha performance of <br /> constructi hat a horized by wner of this property to perfor�n the work for which appfication is made snd I comply with the <br /> State Co , ct6r��a . 7 R - d 0 WAC, <br /> � ; �- f�.� D� <br /> I - igna re of OwnedContractorl uthor¢etl gent Date <br /> �Iz. <br />