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PE�MIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT,WA 98201 <br /> 425-257-8810— FAX 425-257-8857—www.e��erettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �z_ad -�6 <br /> SITE ADDRESS PARCEL TAX I,D.# PERMIT# <br /> i a �ucke� A�c—` �M Lo � z - � <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> � � `f <br /> ;j,,;; ✓���>> �� �- r/ !�2 ,— 1>��� !';. ,� � L—"���.1/``rS�,, ��zi- �>`) - /� �/ <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> r�l lci /s�-.�( ��zs- z3 �— / 7z l <br /> CONTRACTOR ADDRESS � CITY2IP PHONE <br /> Fy/�;., :i�_ 5', irs �t 5�-�,; S��' � L-�.,,{�r ���-� �iz �:��9- z i�/ <br /> CONTR.LICENSE# <br /> .�" %L:JN•;S G"�/L /l L .C'G•ri C �� `f�l?�" / <br /> USE OF BUILDING � � HEAT SOURCE CONTRACT PRICE OF WORK <br /> ✓S F'i — �/L 3 D "-`- <br /> Eleclric �Gas Other I <br /> WORK DESCRIPTION <br /> �,( � , <br /> ) i� ('r�--t;S f. ,, �ic, c i <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air handlinc�units <br /> Balhlub -T Forced air syslems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Water healer <br /> Kilchen sink&disposal Gas fireplace <br /> Dishwashcr Gasrange <br /> CbOies washer Clofhes dryer <br /> Walerhealer Range hood <br /> Sink(serviceNadmop!elc.) Erhausl fan <br /> �ack(low prevenler Heat pump <br /> Urinal Ui�il healer <br /> Drinking Founlain Boiler <br /> Floor drain Re(rigeralion <br /> Greaselrep _ `Noodslove <br /> Roof drains Other <br /> Other <br /> CIN OF EVERETT LOCAL SALES TA7C CO�E IS 3105 <br /> I hereby ceritify lhal I have read and examined lhis application and know Ihe same to 6e true and correcl. All provisions of laws and <br /> ordinaces goveming this lype ot�vork will be complied wilh whether specified herein or not.The granling of a permil does noi presume <br /> lo give authoriry to violate or cancel ihe provision of any olher stale or local law regula�ing consWc�ion or�he peAormance of <br /> conslruclion.Thal I am authorized by ihe owner o(this property to perform Ihe work for which applicalion is made and I comply�vilh ihe <br /> Slate Conlra�lors Law 18.7.7 RCW and 29G.200 V�'AC. <br /> _ ��� <br /> � ��/ �� / : / i� - �` '- C < <br /> ( <br /> Signalure of Ow er/ConlrectodAuthorized Agent Date <br />