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. � <br /> �r � S� �� PERMIT APPLICATI('N <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 (� -'�'�-D�{ <br /> SITE ADDRESS PARCEL TAX I.D.Jt PER�T Jt , �/ <br /> �a � ���� <br /> LEGA LOT N0. BLOCK TRACT OR SUBOIVISION p <br /> DESC. <br /> OWI� ADDRESS CITV2IP PMONE <br /> �/�1'���C_P �/�dI ` �/d - - � <br /> TENANiNAME CONTACTFORPERMIT PMONE <br /> acn� a�� -,�� o <br /> — �p r� e•Ma�d'.cM. <br /> �1 �NTRACTUR � ` 1 ADDqESS CITY/ZIP PHON i _ f- <br /> �-U2v�v�t,�n N��!-� wC. �Co U l 5'� ��u�� � I v.k.wJ-�. ctF!�e Y �\C�..r-�t� <br /> CONTR.LICENSEp bi ' <br /> 13�3�NNH � `1 -r � vZ9 �1��'9�1� �?o� a � Fr '� o0 <br /> USE 0 BUILDING HEAT SOURC� � CONTRACT PRICE OF WORK <br /> �g;cle r� _e�eciric �cias_Other �aDVU ° o� <br /> WORK DESCRIPTION �p, <br /> I {��._C��l � � Ln�� 1 \L <br /> � � <br /> PLUMBING � MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet NC-air handling units <br /> _ Bathlub � Forced air syslems <br /> _ Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kltchen sink&disposal Gas lireplace <br /> - Dishwasher Gas range <br /> Clolhes washcr Clolhes dryer <br /> __ Water heater Range hood <br /> _ Slf�n�swvicnL.n,nwFi,ui�.j Exi�aus�fan <br /> _ Backllow preventer Heal pump <br /> Urinal Unit healer <br /> Drinking Fountam Boiler <br /> Floor drain Relrigeration <br /> Grcase�rap Woodsiave <br /> Rool drains Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TA%COOE IS 9f 05 <br /> I hereby ceritity that I hnve read and ezamined this application and know the same to be true and correcL All provisions o�laws and <br /> ordinaces governin�Ihis Iype of work will be complied wilh whether specified hereir.or noL The granting ot a permit does nol presuma <br /> to give authority lo violale or cancel�he provision of any olher state or local law regulating construction or Ihe pedormance ol <br /> c nsiruction.That I am aulhor� ed by lhe owner ol�his properly to perlorm the work for which appticalion is made and I comply with the <br /> ate Con�ractors La�v 18.27 R and 29G200 WAC. <br /> �% �.��.� G`�{� <br /> , SignaNre of O�mecConiractor� thorized Ac�ent Date <br /> � — <br />