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. -- <br /> PtRMIT APPLICATIUN <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 ACCEPTEO FROM 8 AM TO 4 PM <br /> SITE ADDR[SS PARCEL 7AX I.D.# PERMIT# <br /> 3;0 �•-c'c��E L�e�' (, �E� ��c�or- o�� <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> ��cu�,c(.�r,�� C-� ����l C�n �3 Zr �6� ��,�t�- <br /> TENANT NAME � CONTACT FOR PERMI'� PHONE <br /> (�,1JS�f.N �J��n��c n. Y' 'C����� � �" <br /> 1 J�.l c,�� �2�1'���r�v �j Z-S�� 7So ��-(�'3� <br /> CONTRACTOR � ADDRESS CITY2IP PHONE <br /> ���tiT�����<< ���.�r�,c� �y �Fl S�,»s�t nuf�. �,�� � � ,; . <br /> CONTR. LICENSE# �I I�,r.w�D �'' �jPL.ru'WJCII 't.�� W^1 ' � `��'� ( <br /> � �?7 N 5 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric Gas Other <br /> V�'ORKDESCRIPTION �,rnp� �. Sfw�-.5 E� I 'IO� I'2 r <br /> E�' C� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) _ Gas pipinc, <br /> Shower Water healer <br /> Kitchen sink&disposal Gas(ireplace <br /> Dishwasher _ Gas renge <br /> Clolhes washer Clothes dryer <br /> Waler healer Range hood <br /> Sink(servicelbar/mop/elc.) Exhaust tan <br /> Oackflow preventer Heat pump <br /> Urinal Unil heater <br /> Drinkin� Fauntain �oiler <br /> Floor drain Refrigeralion <br /> Grease trap _ Woodstove <br /> Roof drains Olher <br /> Other <br /> CITY OF EVERETf LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I have read and examined this applicaUon and kno�v the same to be true and correcL All provisions of laws and <br /> ordinaces governing lhis type ot�vork will be complied with whether specified herein or not.The grenting of a permit does not presume <br /> to give authorily to violate or cancel lhe provision of any other state or local law rec�u�ating consWction or the performance of <br /> conslruclion.That I am authorized by lhe owner o(Ihis properly lo peAorm the work for�vhich application is made and I comply with Ihe <br /> State CoN�r cly rs Law 1 .27 RC1N afd 296.200 WAC. <br /> ��c-�%� ;�c������� /-�17- �G <br /> Signalure of OwnedConiraclodAuthorized Agent Date <br />