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PERMiT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � <br /> 425-257-8810 - FAX 425-257-8857 -www.everettwa.org � � ��� <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 1� �D/ - �U(o <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> (p/� D�- i✓JEr2i// CRcoK �i:W. � <br /> LEGAL LOT NO. BLOCK TRACT OR SUBOIVISION# <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> yls <br /> SNF3L - 1,� 5R L^,(eC,S'�7ERa�'i/ G¢et.K PKGJ�/ Eva.ccrr y�20�, yo"1- 0/Z/ <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �'�l �3 r�i� PA.S-�'4� S�C E•MAIL <br /> � ONTRACT R ADDRESS c TYI IP P Zb�- 3 a I—3O� <br /> I 22(eSl - 83�� A�.- So. {Gc.� ; R$o32 <br /> CONTR.UCENSE# <br /> v�r:s;FGI `1bOG77 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> S r p a A E-F �Electric _Gas_Other �J"p Q� `'' <br /> WORKDESCRIPTION `�sr��� �Ew E��Ro rG-ZS GILA �J AcJc�J % �%�G <br /> S�PP,tcss�an! -Sysrer� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FUCTUR�OR ITEM NO. TYPE OF FIXTUf:E OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavalory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas firep�aco <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Waler healer Range hood <br /> Sink(service/bar/mop/etc.) Exhaust fan <br /> Backllow prevenler Heal pump <br /> Urinal Unil heater <br /> Drinking Fountain Boiler <br /> Floor drein Refrigeration <br /> _ Grease trap Woodstove <br /> _ Roofdrains � Olher /���itt3s �c�� S�YSt�.Nf <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS J105 <br /> I hereby ceritify Ihal I have read and examined lhis app�icalion and know the same lo be irue and correcl All provisions of laws and <br /> ordinaces governing lhis lype of work will be complied with whether specified herein or noL The granting of a permit does not presume <br /> lo give authority to violale or cancel Ihe pruvision of any olher state or local law regulating consWclion or the peAormance of <br /> conslruction.That I am authorized by the owner o(lhis property lo perform the work for which applicalion is made and I comply wilh lhe <br /> Stale Contraclors Law 1f1.27 RCW and 296.200 WAC. <br /> '�'.G��-'-- f IlG �oY <br /> Signature of OwnedContrector(Authorized Agent ate <br /> C�L� <br />