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� <br /> P�tRMIT APPLICATIGN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 C� �-ag-05 <br /> 425-257-8810 — FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM l,� ` _ <br /> SITE ADDRESS (�j�S PARCEL TAX I.D.# P RMIT# <br /> � � �� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER j����r��, � AD;�yS _ CITY/ZIP C���� �2� <br /> � �-�.�� �� <br /> _�7�gi�„��.t��z vrR�r- L.Y1 �' z�� tv4cic�o �in �� <br /> TENANT NAME CONTACT FOR PER T PHONE <br /> �A�,�'� �.S �`lE(2 �1���,�, IC� lG�ld �"�� <br /> CCqTRACTOR � �(�^t4DDRESS�O � CITY2IP PHONE ���� <br /> ` f !�`'{�' L}�, �P�YX)lSl-{ �ol''€�(3 <br /> CONTR.LICENSE# '' ' ^�,Q�� �� _ , <br /> +'W� ..������4 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �1� ����=+���� _Electric _Gas_Olher � (�J� � <br /> WORKDESCRI�TION ����J � p� �� <br /> � F�v,�(a-Fca�, � v�e��n�e.� 6e �r.�l, <br /> ci s�h��e �� �e�+�,e �, a���, <br /> PLU BING MECHANICAL <br /> N0. TYP[OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling unils <br /> 6alhlub Forced air syslems <br /> Lavatory (wash basin) _ Gas piping <br /> Shower r�!'�/P� � O _ Watenc�ater <br /> Kilchen sink 8 disposal � , _ Gas fireplace <br /> Dishwasher �;' 1 � -`�� ' '� � � � ' Gasrange <br /> Clolhes washer Clolhes dryer <br /> Laundry tray Range hood <br /> Sink(service,`.�rlmop/elc.) Gxhausl fan <br /> Backflow preventer _ Heal pump <br /> U�nal _ Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ '✓Voodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TlilC CODE IS 3105 <br /> I hereby ceritify thal I have read and examined lhis application and know the same to be lrue and wrrect. All provisions o(laws and <br /> ordina es governing lhis lype of work will be complied with whelhcr specilied herein or not.The granting of a permil dcss not presume <br /> to givc aulhorily to violale or cancei the provision of any other stale or local law regulaling consWction or the performanca ot <br /> conslruclion.That I am aulhorized by the owner o(lhis property to perfonn the work for which application is made and I wmply wilh lhe <br /> Stato Conlr ctors Law 18.27 RCW and 296.200 WAC. <br /> �• � <br /> Signa ure of w Contr clor/A ionze gent Date <br />