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PtRll�llT APPLICATIUN <br /> CITY OF EVEF2ETT PERMIT SERVICES <br /> 320G �:rDAR STREET, EVERETT. WA 98201 <br /> 425-257-8810- FAX 425-257-8857 -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 F M <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> .�:�lll - /1'llri . � � - - - J � _Z <br /> LEGAL LOT NO. ' BLOCK TRACT OR SUBDIVISION n# <br /> DESC. �^ j � �,.�•L_ lVi li. yiZ.i� �YS•�7�� <br /> P� <br /> OWNER ADDRESS CITY2IP PHONE <br /> � � ' �G l9?� l�c�re�r ;�aly /Yl��+z� yz5- ���r�� <i�33 <br /> TENA���AME I CONTACT FOR PERMIT PHONE <br /> y�-jy5'�'j733 <br /> � ,�,/� � e-Ma� <br /> TRA T A ORE55 , �T�'��TP � <br /> �,�{,r�ti� fl e>�cu�:'� 3l�-(�.�l-9�33 <br /> CONTR.UCENSE N <br /> ��iSR�<1�i/�'CS /C'sl'o- 3CC��� /Iliv•S��r�'rls1A 9�`�� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRIC=OF WORK <br /> 5 �.R �[lectric _Gas_Uther J� �,�2'– <br /> WORK DESCRIPTION <br /> � ,,,�.-�.� �x,�f�%ty5f•�� l��'t�i�,�, � l��t�� <br /> � on.9(- Pkv�i.� "�Yi.H�v'�CL�7<� , <br /> I��)J ur'✓lf V �ft <br /> /�Gl� Pllt��n/l�iYr <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FU(TURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> :C Toilel _ A/C–air handling units <br /> �1' Bathlub _ Forced air systems <br /> � Lavatory(wesh basin) _ Gas plping <br /> Shower _ Water heater <br /> �c'_ Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> ,� Clolhes washer Clo:hes dryer <br /> Water healer � Ran�e hood <br /> Sink(service/bar/mop/etc.) X Exhausl fan <br /> Backflow preventer _ Neat pump <br /> Urinal _ Unit heater <br /> _ Drinking Founlain _ Boiler <br /> Floor drain _ Refrigeration <br /> Grease trap _ Woodstove <br /> Roof drains _ Olher <br /> Other — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 � <br /> 1 hereby cerili(y thal I have read and examined lhis application a��d know lhe same lo be true and cortect. All provisions of laws and <br /> ordinaces c�oveming Ihis type of work will be comp�ied wilh�vhether specified herein or noL The granting of a permit does not presume <br /> to give aulhoriry to violate or cancel lhe provision of any other state or local�aw regulating co�sWction or the performance of <br /> conslruclion.That I am aulhorized by lhe owner of lhis property to pe�form lhe work for which applicatio�is made and I comply with the <br /> SlateContraclors Law 18�27 RCW and 296.200 WAC. <br /> ��✓"+'� ��1l�i�— 7������ <br /> Signature of OwnedContractor/Authonzed Agenl Date (/� <br /> ! <br />