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i <br /> PERMIT APPI.ICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> ��.� /CU{ f�S `�-� 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8610–FAX 425-257-8857–www.everettwa.org <br /> �-�f� �'�' APPUCATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDR�SS �S� � PARCEL TAX I.D.p P�RMIT# <br /> CL � � � �.�� '� ' _r`k� 'C/o�_ oU L (170�1i — � <br /> LEGAL LOTNO. BLOCK TRACT� �� (� <br /> DESC. pY� <br /> OWNER ADDRESS CITYTP PHONE <br /> DYti41.r�. .'�1��,,-rf Ttr- �°n3,� 7 /c Fv ��.� rfcn� y11=1sz:T6�"y <br /> 7ENAN NAME I ONTACTFORPERMIT PHONE <br /> �-�FG-�� - `i Zr—y z z -l��y <br /> CON7RACTOR u`/ii 4S h''( � "��'��'S �7�ADDRESS CITY2IP PHONE <br /> r /� <br /> CONTR.LICENSE K T�� <br /> P� ll�x �/c �=�,_ � z ���4,�;- zs�.-36�, <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Electric �Gas_Other Q <br /> I�kO�r�C — I � �,c�, Uu� <br /> WORK DESCRIPTION <br /> �,�1_� �,P f� �'��< c ,�o,� <br /> ��' � - / <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FI%7URE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet AIC—air handling units <br /> � Dathtub � Forced air systems <br /> � Lavatory(wash basin) � Gas qping <br /> Shower � Waterheater <br /> L Kitctien sink 8 disposai �� Gasfireplace <br /> � Dishwasher Gas range <br /> Z Clothes vrasher CloMes dryer <br /> Laundry tray _� Range hood <br /> _ Sink(servicelbadmoplets) �Q Exhaustfan <br /> Oackflow preventcr Heat pump <br /> Urinal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drain Retn�eration <br /> Grnaso trap Woodstove <br /> Roof drains Othor <br /> Other <br /> Cltt OF EVERETT LOCAL SALES TAX CODE IS J105 <br /> I hereby ceritify that i have read and e:camined ihis application and know the same to be We and correcL All provisions of laws and <br /> ordinaces governing lhis rypo of work will bo comp�ied with wfiether spedfied herein or not The granting of a parmit does not presume <br /> ro give authonry ro violate or cancel ihe pmvision of any other state or local law regulating cnnsWction or the performance of <br /> construction. That I am authorized by the owner of lhis pmperty to pertorm ihe work for which application is made and I camply with the <br /> State Contradors Law 1827 RCW and 296.200 WAC. <br /> �_-- � �.� z3 � <br /> Sig re of erlContractorlAut�f pn d Agent Date �/ <br /> L <br />