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1 <br /> PtRMIT APPLICATIbN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810— FAX 425-257-6857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS /� Eyi.�..i{ wA PARCEL TAX I.D.Ji P�RMIT R <br /> /c?GZ C �7��� [. 4e'sial (.� SI� ' / � <br /> LEGA LOT NO. BLOCK iFtACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PMONE <br /> /� 1/�' /� /' yiS-KS'-y�� . <br /> _�dJ'l•� ������ Mlll�l�lai lYG2 /"4Lr/ .� /�lV�. Lv!/.t// . �• (�� � <br /> 7ENANT NAME CONTACT FOR PERMR PHONE <br /> 5 f+1+�•-1 • �n r� �j-�,V u `�✓� 2 cl l. `i 7 a-f�S�`{. <br /> CONTRIICTOR .v1yr0� � J�.+.��� �uh ADDRESS CITY2�P PMONE <br /> , (rcwory� <br /> CONTR.UCENSEII <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Lvµ.�W,�ef ��,t1 I �(Electric _Gas_Other �(�(�"X• �L,UJJ1 <br /> 1.��/. 1✓M�JJ w( <br /> WORK DESCRIPTION <br /> (hST�ll WItiGI(�w5 . L�� Lr.� l f.�C dl �J� IG'11��� <br /> PIUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR 17EM <br /> Tailet A/C—air handling unils <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water healer <br /> Kilchon sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Cbthes dryer <br /> Laundry tray Range hood <br /> Sink(servicelbar/mop/otc.) Exhausl fan <br /> Backflow preventer Heat pump <br /> Urinal _ Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeralion <br /> Groase Irap Woodstove <br /> Roof drains Other <br /> Other_ _ <br /> CITY OF EVERETT IOCAL SAiE3 TAX CODE IS 3105 <br /> I hereby ceritify lhat I have read and examined lhis applicalion and know the same to be true and cortect. All provisbns of laws and <br /> ordinaces goveming this type oi work will be complied wilh whether spec�ed herein or nol.The granting of a pertnil does not presume <br /> to give aulhority to vioiate or cancel the provision of any other state or local law regulaling constructbn or the performance of <br /> conslruction.Thai I am aulhorized by the owner o(this property to perfortn the work for which applicatlon is made and I comply with the <br /> Stale Contractors Law 1827 RCW and 296.200 WAC. <br /> / r;.-�� ,/L'� %J�S�u� <br /> Signature of Owner/ ntractor/Authorized Agent Date i� <br /> � <br />