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PERMIT �PF`�ICATION <br /> CITY OF E�FRETT P�RMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810—FAX 425-257-8857—www.everettwa.org <br /> i APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �Q � z '2 — /!7 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT 1! <br /> "��S � �, Z.;.,��-`, . ' � r °�2�.��� o� (, <, r. -��`��� ���`�`'"' I 1 —U54 <br /> IEGA LOT NO. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHGNE <br /> �;, ,.� . �a�^,��r. -��.s � �,�,:.� �,i.� �� ,_. � �. -> � , �,-�.., �� ��v�-�.5-��- 5 �,���. <br /> TENANT NAME I CONTACT fCR PERMIT PNONE <br /> E•MAIL <br /> q � i I <br /> '�„�/ s`,�,.� �� „ j �.. ��,���`� �:,� � 1E I'i �� C����. :.�, Z�3 �1�.6 l_ �,,.��1 � "�'�,'a�_� <br /> COMR.LIC�ENSE p . <br /> �� 1,5 ''�� '1' � �I�� �-. <br /> USE OF BUILOING I — HEAT SOURCE I CONTRACT PRICE OF WORK <br /> � �. <br /> I�� . Eleclnc �Gas Olher , � C 7 <br /> WORK DESCRIPTION ��\,��,v 2 ��1�'-. C.�� S t-v ( �i� c� � /i'�Z t• `��,c.�" W� i h <br /> �. <br /> S �. (,4.) �' v 1 ',..(,lC . <br /> PLUMBING MECHAiVICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet NC-air handling units <br /> Bathlub � Forocdairsystems <br /> Lavatory(wash basin) Gas pi�ing <br /> Shower Waten c�ater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gasrangc <br /> Clolhes washer Clothes dryer <br /> W.Ier heater Range hood <br /> Sink(service/badmop/elcJ Exhaust fan <br /> Backflow prevenler Heat pump <br /> Unnal Unit hcaler <br /> Drinkiny Fountain Boiler <br /> Floor drain Refrigeration <br /> Gre�sc�rap Woods�ove <br /> Roof dreins Olher <br /> Other _ <br /> CITY OF EVERETT LOCAL SALES 7NC CODE IS 1105 <br /> I hereby certify thal I have read and examined Ihis application and know ihe same to be true and correct. All provisions ol laws and <br /> ordinances goveming this type of work will be complied with whMher specified herein or noL The granting of a permit does nol presume <br /> to give authonty to violate or cancel Ihe provision of any olher slate or local law r�gulaling consWction or the per(ormance of <br /> construction.That I am authorized by the owner of(�tis property to perform the work fo-which applicalion is made and I comply with the <br /> State Contractors Law 18.27 RCW ao429B200 WAC� ' � <br /> _ � <br /> � "— '_ ' �,�� _ �C%�v2 ��/l� <br /> Signalure of OwnedConlractor/Authonzed Agent � Date <br />