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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-E857—www.everellwa.org �'— 1 Z`GS <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS ��,� � ��-� ��� ��, PARCEL TAX I.D.# P IT# <br /> �r,- ��.���i�� j:/. ,� � �;� "2 .� - �OG� �.�1 <br /> LEGAL LOT N0. BLOCK TRACT <br /> DESC. 2. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> i /�'//� (� A J �/ "//� /�/�. �1 2 /J <br /> l"lJ� �� ��� / �L-'�L��J L?!��� L��/`� �/^ ��( �����f�CL.7' �G�-J ��'G�'I <br /> TENANTNAME CONTACTFORPERMIT PHONE <br /> ��i��/1�? �f2�- �c''�-�/,'y'— <br /> CONTRACTOP I�iIi��V���!��li�I4(IZ������ADDRESS pTYIZIP PHONE <br /> ��'`-'•'-'li'/��f�" (.(t�f' ���'l�� ���5-2.�1 �: � <br /> CONTR.LICENSE N ������������� _ X�� <br /> USE OF BUILDING HEAT SOURCE CONTRAC7 PRICE OF WORK <br /> r' �� <br /> ->ii���c J-�l%�'i/�j%�:S �' ' _ ,� _ r� ','% >,-, <br /> ����L�C Electric _Gas Other JJ L ��. d,� � <br /> r <br /> woRKoescaiPiioN C�V'��7� I��Z�!'� 1iCl'L-L' %G� .� 27. `-� ll/1/J� jf�f1' C�l. /ffl'�il <br /> �If2GC' �r��l�,)/D� 7�'`Yt� l/l�/� 'f /G'l'h/ yz'' L"C' f'���f�� <br /> /�'' �°:%�l;' %l tt' 7/l':"1^��I;����1� lt7JG�'l�c.��;",%��%`l'li"/f��/}'�/" '�, <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE 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 /> Kilchen sink 8 disposal Gas fireplace <br /> Dishwasher Gasrange <br /> Clalhes washer Clothes dryer <br /> _ Laundry Iray Range hood <br /> Sink(service/bar/mopletc.) � Exhaust fan <br /> _ Backflow preventer _ Heat pump _ I <br /> Urinal _ Unit heater \ U �. ��� <br /> _ Drinking Fountair ,_ Boiler �� `. <br /> Floor drain Refrigeralion <br /> Grease lrap _ Woodstove <br /> Roof drains Other <br /> Other <br /> GTY OF EVERETT IOCAL SALES TAX CODE IS�105 <br /> I heieby ceritify ihal I have read and examined Ihis appliwtion and know Ihe same to be true and correcL All provisions ot laws and <br /> ordinaces goveming this type oF worA will be complied with whelher speci5ed herein or not.The granling of a permit does not presume <br /> to give authority;o violate or cancel Ihe provision of any other stale or local law regulating construction or the performance of <br /> conslruction.That I am authorized by Ihe owner of this property to pedorm Ihe work for which application is made and I compty with tl�e <br /> StaleCo �apto�sLaw/�827�CW,ar�d2�J6.200WAC. <br /> /; '� %' l�/,�� ��;%_�i/�)� <br /> � Signaluro of Owner/Con c r AGthorized Agent Date i/Z <br />