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F �RMIT APPLICATI�.N <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETf, WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � —�,f) �Q <br /> SITE ADDRESS / �/C r✓u�5 /f PARCEL TAX I.D.# PERMIT# <br /> 1,��, ;� / �✓ /1 �� �s �!�� �� 7.::� � ,;:; �, c:c 1;IC�61 - d l 5 <br /> LEGAL I.OT NO. BLOCK TRACT OR SVBDIVISION/#/ �� <br /> DESC. y1� � �� <br /> .,2 " 2 3� c�- � / /�� o/ �✓�•�� id;sio/! �/U �4op( <br /> OWNER ADDRESS CITYIZIP PHONE <br /> =' J �- r= ��=�� -' �� � r <br /> TENANTNAME CONTACTFORPERMIT PHONE 3(oU GS J S6S <br /> '/ I !' :ZGYo G(�9-oi6 9 �, <br /> `�i�Jrri .',�' /CG��I�/ /I ('/ri�� Y-LS E•MAILKH/hh�f�.J{lPS �7C�t.^���� <br /> A R oSvvw,�, Cov,crs�� F�°w�;,..� �`l`l�b 5� A�c Al� 3f� lnSz - `/�3i��- <br /> CON7R.LICENSE R � /-�( Ii r 1�oYl �A <br /> L�-,�..�.� � r r' (•=(- /� � � i q8 �7,.3 <br /> USE OF BUILDING HEAT SOURCE I C�TRACT PRICE OF WORK <br /> �"��'�ti�C, _Electric �Gas_Other /L!' i'S�� <br /> / <br /> WORK DESCRIPTION i{��S � S �l / 4�7U 1�c�r,c �u j/, ,. c��•lf� vud l9y.1 ��r/��r., � <br /> W $('C �li� n C�� Cor�C��r � r' 17GS L�.�.1 -/� �� Gn�,a � f si�a<� �,� Cl �w.-s'� U �1 �1• <br /> N �3 fl. r�•� 1, .-., f{�n�� Hq� ,�c� �/��.,..f�/a./.�..� (c%/ ccnr sl,..i��a. <br /> 71,<•, .- � s n <br /> // ll���� SCt�lC�r .lil[r IP�l�4r� /Y � / �� �7P(t. �S n Z��r <br /> }�P IY-,C l' C �--T.'�}_�AF�` <br /> atrn n.�l /o� ne:- 1 �:�� •�:, H t �e 1G r � <br /> PLUMBING MECHANICAL ' <br /> NO. TYPc'OF FIKTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> Toilet NC-air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Water healer . Range hood <br /> Sink (servicc/bar/mop/etc.) _ Exhausl lan <br /> Backflow preventer __ Heat pump <br /> Urinal Unil hea�er <br /> Drinking Fountain _ Boiler <br /> Floor drain Re(rigeration <br /> Grease irap _ Woodstove <br /> Roof Jrains Olher <br /> O�her <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> 1 hereby certi(y that ;have read and examined this application and know�he same lo be true and correcL AI�provisions ot laws and <br /> ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume <br /> to yive authority to violate or cancel lhe provision of any olher state or local law regulating construclion or the performance o( <br /> consiruction. That I am aulhorized by tlie owner of this property�o perlorm ihe work for which application is made and I comply with the <br /> State Contractors Lmv 18.27 RCW an�9620\WAC. <br /> :> _ , .. � �i-: <br /> �il ' t -��� �.L % ��_� <br /> Signature ol OwnedContraclodAuthorized Agent � Da�e <br /> �IZ <br />