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PE�2MIT APPLICATION <br /> CITY OF �.VERETT 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 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# /�� <br /> �� L(� � �(�rr ,1.� C.if 1/%- � 7� � L-.J <br /> . <br /> LEGA I.UT NO. BLOCK TRACT <br /> D[SC. <br /> OWNER ADDRESS CITY2IP.,y. PHONE <br /> /L �. - ^ 7 �v�.rX/ � J�7- �-5 %' j7 7:� <br /> �- %;-c�,� � e ; �/ r, '�3zc� �,� < „�•,7` G,— � ., �. � �' - <br /> TENANTNAME CONTACTFO PERMIT PHONE <br /> ��� �C r � �, t/� ��7 7-?y-`/- ,�/�� <br /> CONTRACTOR . ADDRESS .�+.�. CITY IP PHONE <br /> �" %�n./�• �� �, � 5'�v �lC � L`"� /�` (/ .�jto`� GvlL��$'`c' i s�LT- 17`/'Z ��� <br /> CONTR.LICENSE# <br /> l yL �A.`i 5a�/Lk'L <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> :� <br /> ��� �Electric� _Gas_Olher � 3�n <br /> WORK DESCRIPTION <br /> /I^/ / �^ ��rC � ��rrr':Il' /�� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet PJC-air handlin� units <br /> Bathtub � Forced air syslems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Water heater <br /> 6nchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gasrange <br /> Clothes washcr _ Clothes dryer <br /> Water heater Range hood <br /> Sink(service/badmop/etc.) _ Exhaust(an <br /> Backflow prevenler _ Heat pump <br /> Urinal _ Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeralion <br /> Grease trap _ Woodstove <br /> Roo(drains Other <br /> Olher — <br /> CITY Oi'EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify thal I have read and examined Ihis application�nd kno�v the same to be lrue and correct. All provisions of laws and <br /> ordinaces c�oveming lhis type of work�cill Le complied wilh�vhether speci(ied herein or not.The granting o(a permit does not presume <br /> to give authority to violate or cancel the provision of any ulher state or local law regulating construction or the performance of <br /> construclion. That I am aulhorized by the owner of this property to perform the work tor�vhich applicalion is made and I comp�y with the <br /> State CoPtrac.tors Law 18.27 RCW and 296.200 WAC. <br /> � � �G'V � - /���1' � <br /> l .' <br /> SignaWre of Owned onlraclor/Authorized Ac�ent Date <br />