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1 <br /> � 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 - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# ERMIT M <br /> z1 �3 MAv� c, 5� . 2�n�2o� ► c,onao �l '2 -CX�/ <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER AODRESS CITVZP PHONE �(pp — <br /> '�ENNIFE e kLLqt-L 2� 131 ID4 �'h 1�2 N it� s'(IatJi.�`M D t)� �.q a- (oZ�i - 2"1G0 <br /> TENANTNAME I CONTACTFORPERMR PHONE <br /> � ���r�l�. mATH�sc5n3 3t�n. - 4�S- ��1ce <br /> CONTRACTOR �.I�V GNF�G �.��VILES ADDRESS �C�[)�U G1 4d_. arvma PHONE �j(�Q- lJ�� - <br /> y N� �,z��n,vra� �� r � <br /> CONTR.LICENSE K'� �� � � E S 1 G« N N �3 �J�ZZ3 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> QE.NTA(l I�D�`'�- _Electric �Gas__Other <br /> WORK DESCRIPTION �NST A L� / N Lr /� Cc�m gr rv � t�On1 }�O'r LAJq T L-�L <br /> 1�6A7�2 �� !-aGrf W4Tt-2 l3/aS�l3nA�fJ f-�L•"�i <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%TURE OR ITEM NO. NPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) I Gas piping <br /> � Shower f Water heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clothes dryer <br /> Laundry lray _ Range hood <br /> Sink(service/barlmopletc.) _ Exhausi tan <br /> Backflow preventer _ Heat pump <br /> Urinal Unil heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease trap _ Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3705 <br /> I hereby ceritify that I have read and examined this application and know the same lo be true and correct. Ail provisions ot lews and <br /> �rdinaces govarning this lype of wark will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to grve authority to violate or cancel the provision of any other state or local law regulating construction or the peAormance oi <br /> cons�ruction.That I am authorized by the owner of this propeAy to perform the work for which application is made and I comply with the <br /> Stace Contractors Law 18.27 RCW and 296.200 WAC. <br /> �11c�r �� ly��r � l� r_v� �a-� -o�t <br /> Signature wner/Con ractor/Authorized Agent Date <br />