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� ---- <br /> PERMIT APPLICATIDN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425-257 8857-www.�verettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � � 7 _;�� <br /> � <br /> SITE ADDRESS PARCEL TAX I.D,il PERMIT# <br /> �y� � ��:�,�� �z� ��.��� ,�,� � ,a-or <br /> LEGAL LOTNO. BLOCK TRACT <br /> DCSC. S <br /> OWNER AODRE55 CIN21P PHONE <br /> �t�.f-' c�a�JZ'zF-�a:i5c'� <br /> TENANT NAME CONTACT FOR PERMI7 PHONE <br /> CONTRACTOR ����yN�N �I�.iltG• ADDRESS CITY2IP PHONE <br /> z�!-�•3�� i2vr,. 4��-,•.0 3�uyou3 �ybi <br /> CONTF.LICENSE�/ �o��^,�� 27� � z ��?�/.�C•n.'�- q5"z7 3 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE Of WORK <br /> .�+/-/� I _Elednc _Gas_Other .�c�D'i.J <br /> WORK DESCRIPTION <br /> i.�:S:'-tu h=�i1r S�i',...t�[<-J,' , n� Nc�. Sr�c. <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. NPE OF FI%TURE OR ITEM <br /> Toilet _ A/C—air handling units' ' ' � � • <br /> E3alhtub Forced air systems <br /> Lavalory(wash basin) _ Gas piping � <br /> Shower Water heater , <br /> KOch. n sink 8 disposal _ Gas fireplace <br /> Dishwasher Gas range � <br /> Clothes washer Clothes dryer <br /> Laundry tray _ Range hood <br /> Sink(servicelbadmoplelc.) [xhaust fan <br /> Backflowpreventer _ Heatpump <br /> Unnal Umt heater <br /> , Dnnking Fountain _ Boiler <br /> Floor dram Refngeration <br /> Grease lrap _ Woodstove <br /> I _ Roof drains _ Other <br /> Olher <br /> i _ �c� NPFFiI�S_ <br /> CIN OF EVEREtt LOCAL SALES TAX CODE IS 7705 <br /> I hereby centify that I have read and ezamined this application and know the same to be We and coveq. All provisions of laws and <br /> ordinaces goveming thls type of work vnll be mmplied vnth whether specified herein or no[ The granting oi a permit dces nol presume <br /> to give authonty to violate or cancel the provision of any�ther slate or local law regulating wnstruction or lhe pertortnance of <br /> consiruction.That I am authorized by the owner of this property to pedortn the wnrk for which application is made and I comply with the <br /> Slate Contractors Law 1 27 RCW an �6200 WAC. <br /> l_.��I � ���� 7 �2 r �c710 <br /> Signature o Owner/ ontractor/Au�ho�zed Agent Date (� <br /> � <br /> c <br />