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PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CCDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8657-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> .`tJhL Q���•�..�ell,2��aL�-i_ �'��; ?O � U' 0� 3`6U3pZu � -1ZG� i��D�-ca--nc:. <br /> LCGAL LOTNO. BLOCK TRACT <br /> DESC. ,!' � �� <br /> OWNER A�ORESS CITYIZIP / PHON � S•�� <br /> � � � t`—`Cx-L �C_Y ���Zo � <br /> �L�..�.{ ' , �-c-�, �.�. `a«,�r n1����, �`��z 1:�,4�-e,l��..� <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> N ��- Co--•-C�-� ..,. �1.�1-c_.lD��- l `��v�11 �s `��s,Y <br /> CONTRAC701t �/— ADDRFSS �— --Y�� I�,� � CITYILP PHONE ��.7 — <br /> �(/ASN�/��t-7til 1�.,7Tc � ;5�_> Y/ /1 �L 7 , i <br /> �LL.:« f� .°•> ,_,.��.,/hr. ,;� �� S y7b� <br /> CO!:iR.LICENSEII ^ ` ��� ''� ����' <br /> �G�t3`S/-L7���/`���(, 'l � ' — <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> (� i ` <br /> _Electnc _Gas_ Other �J G' �� f� <br /> WORK DESCRIPTION • � ��_��- (��1LCF—yZ <br /> �.�LCer�-C (�'�-� � �G`� L.�(, , <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilel _ A/C—air handling unils <br /> Ba1hWb _ fo�ced au syslems <br /> Lava�ory(wash basin) — Gas pipi�g <br /> Shower Water heater <br /> Kitchen sink&disposal � Gas tueplace <br /> Dishwasher _ Gas�ange <br /> Clolhes washer _ Clothes dryer <br /> Laundry tray _ Range hood <br /> Sink(servicelbadmop/elc.) _ �xhausl tan <br /> BackFlow preventer _ Heat pump <br /> Uiinal _ Unit heater <br /> Drinking Fountain _ Boder <br /> Floordrain _. Reingeiation <br /> Grease trap _ Woodstove <br /> RooF drains _, Other _ <br /> Other — -- <br /> CITY OF EVERETT LOCAI SALES TA%CODE IS 3105 <br /> I hereby centity Ihat I have read and examined this application and know ihe same to be true and correcL All provlsions of laws and <br /> ordinaces goveming�his type of woik will be cnmplied wilh whether specified herein or not Tlie grantmg o(a permit does not p�esume <br /> to give authoiity ro vlolate or ca�cel Ihe provision of any olher sla�e or Iocal law regula�ing consiructinn or Ihe performance ot <br /> consWction.That I am authorized by Ihe owner of�his property to p=rform the work for which apphcaUon is made and 1 comply with the <br /> S le Contradors Law 1827 RCW and 29G200 WAC <br /> r <br /> / <br /> �a�� ., i�•� �`� � -��'1 �G'b <br /> Sgnature of O ned ontradorlAuthonzed efi 1 Date r� <br />