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PErtMIT APPLICATIOIv <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 ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TN(I.D.# PERMIT# <br /> -;�z 3 ��r��x ,���b� ,� � G-o� - �/ <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS C�TY21P PHONE <br /> l��,e c-a-(rz.�Pn <s�5 <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> !/c�: �sSi�✓so,. - L 7.nsc«. (3E'O�°7 �1`6Z <br /> CONTRACTOR �g�Nso..� �h.xb • i�—G ADDRESS CINfZIP PHONE <br /> ���.Jv /2.'�n� AvL Nt- �SGc�Y� f �KGL <br /> CONTR.LICENSE M WUti �(-Z L <br /> �Ava.,..o�r � „_� z a��,� 3 <br /> USE OF . UING HEAT SOUFCE � CONTRACT PR�CE OF WORK I <br /> 5 /=j2 _Electric _Gas_Olher Y 3S"�� <br /> WORK DESCRIPTION <br /> /.c�5 J�cc F-�i c: ;.�'�''....rcc-v:�� i..i �� S F� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURf:UR ITEM N0. TYPE OF FI%TURE OR ITEM <br /> Toilet _ A/C—air handling units <br /> Bathtub _ Forced air systems <br /> Lavalory jwash basinl _ Ga� pipinc� <br /> Shower _ Waterheater <br /> Kitchen sink 8 disposal _ Gas firep�ace <br /> Dishwasher _ Gas rangi� <br /> Cblhes v�asher _ Clofhes dryer <br /> Waler hea�er Range hood <br /> Sink(service/bar:moplelc.) _ E>hauslfzn <br /> �ackflow prevenler _ Heat pump <br /> Urinal _ Unit hcater <br /> Drinkin�Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Grease irap _ Woudstove <br /> Roof drains Other <br /> Olher — <br /> — �_ Ca9>7 S <br /> CITY OF EVERETT LOCAL SAIES TN(CODE IS 3 i05 <br /> I hereby ceriti(y that I have read and examined Ihis application and know lne same to be true and correct. All prcvisions of laws and <br /> ordinaces goveming this type ol work will be complied wilh whelher specified herein or nol The granling ol a pertnl:does not presume <br /> to c�ive authoriry lo violale or cancel lhe provision ol any other stale or local law regulating construction or lhe performance ot <br /> construction.That I am authorized by the o�mer o(this property to peArrm ihe work for a•hich epp��calion is made ard I comply with the <br /> State Conlractors Law 18.27 RC��nd 296.200 WAC. <br /> � !�Y � '�/�rib <br /> S natu��o vmedContreclod�uthonzed Aye�t D&te / \ <br /> y <br />