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PERMIT APPLICATlON <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 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 'p IM �'&L?9'o`I d' <br /> �rY.?d' �l�iV�' '�' l,;i�'_t.� 7�lUc)( — <br /> LEGAL LOT NO. BLOCK TRACT UR SUODIVISION tt <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE 33,{ <br /> l�rl� � �'�,�i1��� J1 u �f� ?���i�, ����' v,�,� ��13��.n! C�-��'rj`� y.�'���3 <br /> y.'S �>v" - <br /> TENANTNAMJ CONTACTFORPERMIT PHONE �_23_� ?y-3a1� /�`'r�E <br /> � .y- , �cC 9'Ij O.7hi';'� / � <br /> r_?} Ir. �J� �1��'1,l Il S�- <br /> CI�-� J ��IC � I<<�� � E•MAIL <br /> CONTRACTO � ADDRESS CITY2IP PH N <br /> f`l.-/1) ✓ �.�,1)I, c" .� <br /> CONTR.LICENSE# <br /> USE OF BUILDING I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> i <br /> �)����)�' _Electric _Gas_Olher <br /> WORK DESCRIPTION <br /> PLUMBING MECHANICAL <br /> Np, TYPE OF FIXTUFtE OR ITEM NO. TYPE OF fIXTURE OR ITEM <br /> Toilet _ A/C-ai•handling units <br /> Dathtub / � Forced ar systems <br /> Lavatory i�vash basin) 3 V Gas piping <br /> Shower _ Waterhealtr <br /> Kitchen sink 8 disposal _ Gas lireplace <br /> Dishwasher _ Gas range <br /> Clothes washer _ C�othes dryer <br /> Waler healer _ Range hood <br /> Sink(service/badmoplelc.) _ Exhaust fan <br /> 6ack(low prevenler _ Heat pump <br /> Urinal _ Unil healer I <br /> Drinking Fountain _ Boiler <br /> Floordrain _ Refrigeralion <br /> Grease lrap _ Woodstove <br /> Roof drains _ Other <br /> Other — — ' <br /> CIN OF EVERETT IOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify Ihat I have read and examined this application and kno�v the same to be true and arrect. All provisions o(laws and <br /> ordinaces goveming this type of work will be complied with whelher speci(ied herein or noL The granting of a permi;does not presume <br /> to give aulhoritv to violate or cancel the provision of any o�her stale or loca!law regulating wnsWclio�or the performance ol <br /> construction. 7nat I am �uthorized by the owner of this property lo perform the work for which applicalicn is made and I comply with the <br /> Stale Contractors la� 18.27 RCW ai 58.200 WAC. <br /> I c � ���.�� J- � % - �' b' <br /> Signat of OwnedConlractodAuthorized A9 nt D2le <br />