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P�RMIT APPLICATIUN � <br /> CITY OF EVERETT PERMIT SERVICES 1 b�� <br /> 3200 CEDAR STREET, EVEREIT,WA 98201 �� ' <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org 1 <br /> 7�L�7 APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM `v`O ( I-�� -06 <br /> / <br /> SITE ADDRESS PARCEL Tiil(I.D.# PERMIT# <br /> `�-1= ��, 9 �� <br /> ��� P�- '; I , CY �Ot?7 -rJ/Z -UI �7�! OGL) <br /> LEGAL L T O. BLOCK TRACTp �] <br /> DECC. J �'r� D{ C" ���.t � 1 �r , S� 6LY,�✓�Ji:�. `� IZCL - /� -i�Z <br /> OWNER A DRE55 CITY2IP PHONE <br /> ��� I-��"la;..�f /�ic ,;,r—.�z,� cc! �'iv2 _ � � A ���G y�r ��f- ,rr�/ <br /> n�+u: <br /> TENANTNANE CON1-ACTFORPERMIT PHONE <br /> ti �, � , , r <br /> ; ' I r� r,.�,r.�.���,�' �: yzf, yza �r�d- <br /> �:� - <br /> CONTRACTOR ��\� E � � �. ADDRESS � l CITY2IP PHONE • <br /> �� n ✓ �^.�r Jx <br /> • , , ��/V•,'�}'�-./jy,. ��i �O� `. Y1I' 7�I" y>!'1�� . <br /> CONTR.LICENSE# �/�/2�/Vi.�t��2GTG i . � � ' �' 1�/hncLft[•! f�C/J� � ,. .• <br /> � :�' i/. / <br /> USE OF 6UILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> S f' �` _Electric �Gas_Other �7�1�.� <br /> i <br /> WORK DESCRIPTION <br /> ��� !V'+"u� �f /� N i,l� 1/—/� <br /> ��,cG, l� 7 (i�ir� <br /> PLUMBING MECIIANICAL <br /> NO. NP[OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> � Toilet A'C-air handling units <br /> Balhtub � Forced air syslems <br /> �_ Lavalory(wash basin) � � � Gas piping <br /> ,1_ Sho�ver �_ Water heater <br /> / Kilchen sink 8 disposal / � Gas fireplace <br /> _� Dishwasher �_ Gas range <br /> � Clolhes washer � 1_ Clothes dryer / <br /> _� Waler healer _� Range hood <br /> Sink(serviceNadmop/etc.) ��jj_ Exhausl lan <br /> Dackllow preventer �} /� _ Heat pump <br /> _ Urinal / /�� Unit heater <br /> Drirkin� Founlain h j `> _ Boiler <br /> Flonr drain `- Re�rigeration <br /> 3re ase Irap Woodslove <br /> Roof drains Olher <br /> Other <br /> CITY O�[V[RETT I.00AL SALES TAX CODE IS 3105 <br /> � I hereby ceritify Ihal I have read and examined this application and know ihe same lo be lrue and correcl. All provisions ot laws and <br /> ordinaces goveming this lype d work will be complied�eilh whether speci(ied herein or not.The granting of a permil does nol presume <br /> to give aulhoriry to violale or cancel lhr. provision of.ny olher slale or local law regulaling conslruction or the performance ot <br /> conslruclion.Thal am aulhorized by IhQ owner o(this property to perlorm Ihe work for which application is made and I comply wilh the <br /> S�le`oNracto �,� .27 RCW and 29G.200 WAC. <br /> � '- � "� J , /Z� CJ � <br /> Sic�naWre of O�vne Co tractor/Authorized Agent i Da�e �Z <br />