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( <br /> PERMIT APPLICATION <br /> ( CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,W� 98201 <br /> 425-257-E810- FAX 425-257-8857-www.even�ttwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM"f0 4 PM <br /> SITE ADDRESS �J PARCEL TAX I.D.Y �ERMI � / � O � <br /> �O ✓I - ��/�--�J• " p ._o _oCxf' -4_) -00 VV �a �. <br /> DESC. LOT NO. BLOCK TR�T`t��B�IVIS�ON IJ7 _��� ���G / �_��� � S <br /> � �1r_ �L� -C�� <br /> OWNER ADDFESS . CITY/ZIP PHONE l, <br /> L y'lvrJCQo ��� /nn.� � �??�L�-i�'S /�/ !i1/.2ht�L/ //vi� b?�� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> E�IIAIL <br /> ONT i/ys/u...�/c�. iYi.r _/«.�d�]n$ o . ,,?Gis w�'�tiy � 'lZ5 3�h7Jy/Y <br /> � '�on�d #'?_C-� �vc.4c�-O' Gc.t�1 <br /> CONTR.LICENSE Jt ��'j�+, <br /> /vigs///A/�`j f/3 L/.� <br /> USE OF BUILDING HEAT SO�IRCE CONTRACT PRIC�WORK <br /> — — V 1 �l/ —_ <br /> Electric Y Gas Other <br /> WORK DESCRIPTION �,y�pA� ��.�..yu� ��ye��� �G�' ��d�,�(�,�iJ <br /> /•�-- <br /> PLUMBING MECHANICAL <br /> N0. 1YPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub � Forced air systems <br /> _ Lavatory(wash basin) _ Gas piping <br /> Shower __ Water heater <br /> Ki;chen sink 8 disposal _ Gas fireplace <br /> Dishwasher _ Gas range <br /> Clothes washer _ Clothes dryer <br /> Water heater _ Range hood <br /> Sink(service/hadmop/etc.) _ Exhaust fan <br /> BackFlow preventer _. Heat pump <br /> Urinal _ Unit heater <br /> _ Drinking Fountain _ Builer <br /> Floor drain _ Retrigeration <br /> Grease trap _ Woodstove <br /> Roof drains _ Other <br /> Olher -- <br /> _ I <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> I hereby certify that i have read and examined this appliwtion and know the same to be true and correcL All provisions of lav. 3nd <br /> ordinances governing this rype of work will be complied with whether specified herein or noL The granting of a permit does nol,�resume <br /> to give authonry to violate or cancel lhe provision of any other state or local la�v regulating wnsWction or the performance of <br /> construction. That I am authorized by lhe owner of this property lo pertorm the work for which application is made and I comply with the <br /> � State Contracrors Law 1827 RC d 296200 WAC. <br /> C "%>.C�G�(o1 �Z ��/�2 <br /> �Signature of OwnedContractorlAuthonzed Agent Date <br />