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P�RMIT APPLICATII,N <br /> CITY OF EVER�TT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8857 -www.everethva.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> i <br /> SITE ADDRESS PARCEL TAX I.D.# P RMIT� I <br /> � �c;� NiE�krLcC'�r� � io'Y G'2S't,��3vi�sonu � � 5 0/ — v3/ <br /> LEGAL LOT N0. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> �� �� r � �/ (� <br /> �t(dl�/�'I�i�/:G'���0•�• ��C �jC�aGQa�✓r�5��y5d, �7�SS.,70 �1e-4�� . <br /> lE�ANT NAME � CONTA T�OR PERMIT PHONE <br /> � � � / ' <br /> 'J��:.1 Jr�:� �%t:F;'✓�ki� �Zs- b��/-EC1% <br /> CONT�ACTOR ��o h���'�- '�PN�/ <'�� A�DRESS J,��� [� CITY2IP PHONE <br /> //7��L�ti�" GO���✓q� (/,Ctt�i=.ti��-� �,+� <br /> CONTR.LICENSE# ' � ?�'S / �7' C���� <br /> FC H���'c:l�l I C� � s �=N <br /> USE OF BUIL�ING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Electric _Gas_Other /����Z/ <br /> WORK DESCRIPTION � ? ' <br /> T n!��.�G�%a.l�uw �;;� o- /:�...,i� I ��� ff .:_i,�c.c✓ ��� . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling unils <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backflow preventer Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain Boiler <br /> I _ Floor drain _ Refrigerelion � <br /> _ Grease trap Woodsrove �t � �' t/7� <br /> � Roof drains i Other C /��7lZ <br /> I _ Other _ <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I hav� read and examined this application and know the same to be true and correct. All provisions of Iaws and <br /> ordinaces governing this ype of work will be complied with whether specified herein or not The granting of a permit does not presume <br /> ! to give authonty to viola�e or cancel the pro ision of any other state or local law regulating construcGon or the performance of <br /> construction.That 1'ar�authorized by the w r of this property to perform the work forwhich application is made and I comply with the <br /> State Contractor La14 1827 RCW and 00 WAC. / <br /> � � .� 1 �7 � r <br /> � ��'.[i(..( ' %� ,f�� / —L-7— �'� � <br /> � Signawre of OwpenCont tor uthonzed Agent Date �/ <br /> � �v <br />