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t <br /> PERMIT APPLICATION <br /> CITY OF EVERET7' PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERL•1T,WA 98207 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> -, <br /> n ., <br /> � APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM /O " 3'�'"�� <br /> '` -,�--7. ��2( � <br /> SITE ADDRESS PARCEL TAX I.�.11 PERMIT I <br /> 3�~1 M�7c�—ra`C--fJ.�E l G- I b - <br /> LEGA LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CfT`/ZP PHONE <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> ��1C C'Ab�-+'�:2_�7�5 � �w�l �.:��JJ J�-/�/�f <br /> CONTRACTOR p��� �'�� � `�F,'��y. pDDRE55 CITYlZIP PNONE <br /> _z,(.,o -�55 5�+�/�/ <br /> CONTR.UCENSER /ac.,�„�l��ci.-�.�,��, `�CU i3vx ���j 1�,✓rL+�-e��trJ Lv4 �4a3 � <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT P21:•E OF WORK <br /> ElccUic Gas Other �' <br /> « � �_,vtJ <br /> WORK DESCRIPTION <br /> 1 '-�1A� (l ��c.iit .i_.t�'. �1�.:. < .�f.r . , �c�� �l.t.� l � i <br /> «-f':• (^ ._ �:� � <br /> PLUMBING MECHANICAL <br /> NO. TYPE(1F FI%TURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C–air handling u�its <br /> Bathtub Forced air syslems <br /> Lava!ory(wash basin) ,as piping <br /> Shower Water heater <br /> Kitchen si�k&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dry¢r <br /> Laundry:ray Range hood <br /> Sink(serviceft�arimopletc.) Exhausl tan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeralion <br /> _ Greasr I�ap Woodslyo e , <br /> Rooidreins ;` Other 1-� S�.v�n�-�S.S�v.� <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 7105 <br /> I hereby cerilify ihal 1 have read and examined lhis appliwtion and know Ihe same lo be lrue end corred. Ail provisions oi laws and <br /> ordinaces goveming lhis type of Krork will be wmp�ied with whether specifed herein or noL The granling of a pertnil does nol presume <br /> lo give aulhority to violate or cancel lhe provision ol any other slale or lowl law regulaling consWdion or the pedortnance of <br /> consiruction.That I am ault�orized by lM1e owner of Ihis property lo pedorm lhe work for which application is made and I comply wilh the <br /> State Contrectors Law 1827 RCW and 29G.200 WAC. <br /> �r'. . .� �._j-r--� I�� ll��b6 <br /> Signature of Owner/ContrectorlAulhonzed Agent Dale � <br /> � <br />