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PEFtMiT APPLICATIOIv <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-885? -www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM ��_ S'� Q� <br /> SI7E ADDRESS PARCEL TAX I.D.J7 PERMIT#. <br /> �l� //,�����,-„�� �� �1���i/-�=� <br /> LEGAL LOT NO. �BLOCK TRACT OR SUBDIVISION f: <br /> DESC. <br /> OWNER ADDRESS CITY.�p.. PHONE <br /> �'L f'C!�(/ <br /> , �rt/� Ti'��r,T,a 5`�� ���r�L�,�,;�'< ��- 1�zo3 y�5 _ z�-��sj,51 <br /> TENANTNAME CONTACTFORP RMIT PHONE I <br /> E•MAIL <br /> CONTRACTOR ADDRESS �/� TY/ZIP P O�E —!� <br /> ��.��i��r✓ ✓4 �Ps 1'- `Xio�,�C 3c�C l,Evr�.�G�.7� � y Z S —Z� / —2 /�� <br /> CONTR.LICENSC N ���')�:� <br /> L=�<.�/VSSc�fLK2- ���� �� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> .�� � t�. <br /> (�� _Electric �Gas_Olher /9� ] <br /> WORK DESCRIPTION <br /> //� <br /> ��=n����� 9� /1 �O�-'�- �� iri�'J� e <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toil�d A+C—air handling unils <br /> �aU.lub _L Forced air syslems <br /> Lava:ory(wash basin) Gas piping <br /> Sho�:cr Waler hea�er <br /> Kilchen sink&disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Clothes washer Clolhes dryer <br /> Walrrheater Rangc hood <br /> Sink(service/badmop/elc.) _ Fxhaust(an <br /> BacMlow preventcr _ Heat pump <br /> Urinal Unil healer <br /> Dr' ���ing Founlain _ Boiler <br /> Flo :drein Refrigeration <br /> Grease Irap _ Woodstove <br /> Roof drains Olher <br /> � Other <br /> CITY OF EVERETT LOCAL SALES TA%CODE IS J105 <br /> I hereby ceritify that I have read and examined ihis applicalion and know ihe same lo be Irue and correcl All provisions ot laws and <br /> Iordinaces goveming this typr.of work will be complied wdh whel'ner specified herein or not.The granling o(a permil does nol presume <br /> to give authority to violale or cancel tho provision of any other state or local law regulaling construction or ihe pertormance o( <br /> conslruclion.That I am aulhurized by ihe owner ot this property to perform the work for which application is made and I comply with the <br /> Stale Conlradors Law 1827 RCW d 296.200 WAC. <br /> I Signature�ol Owner/Cont�r'/�zed Agent //' Date� � I <br /> I ----------.._ ._ _._ - � <br />