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PErtMIT APPLICATIO�J <br /> CITY OF EVERETT PERMIT SERVICES 3�0�`"°� <br /> I 3200 CEDAR STREET, EVERETT, WA 982U1 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org {�-�— <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS P.RE NOT ACCEPTED <br /> SITE ADDRESS ,��-� � , , PARCEL TAX I.D.# PEF�71T# <br /> � � � � 2 ;'�1 <br /> �,���'i: _)-rc�t1��<� . . / ' ,'I' 0C5 �� 7jn-C/eG•i�^/ � _ '`�� <br /> LEGAL LOT NO. BLOCK � �i� TRACT • � <br /> DESC. � I � ��� I � �� I%� �(�IG� �S <br /> OWNER ADDRE55 CITF2IP PHONE tfzj <br /> �Gl� �.�..0 �-o, �oK. Z�G9 �Y^'^' 4�a3� 77�- �8L91 <br /> TENl,NT NAME CONTACT FOR PERMIT P�10NE <br /> i ►.� l�-- M��A-�'L K�.2 '�2� 77�-58'L�'j <br /> CONTRACTOR � ADDRESS CITY2IP PHONE y2.3� <br /> ��T�-�u c���-f�v �o•3ox. Z��`i �.yti� sa�� 7��-�BZ� <br /> CONTR.UCENSE# � �T�C�,� y7Z �,� __ <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WC�RK <br /> 5!�-+��—� ��"'��� _Eiectric �Gas_Other � Z8�� 0�� <br /> WORK DESCRIPTION � S ��� � ��'�• / ,/ � 'q(,� �Z.CS <br /> �,' h��,.�� o N S� <br /> G�s-Fa�c�— / <br /> � , ,� _� ,� <br /> ���- y- / �l,�; t '��C�7� �'<< - : <br /> �. <br /> PLUM8ING MECHANICAL <br /> INO. TYPE OF FIXTURE OR ITEM IVO. I TYPE OF FIXTURE OR ITFM <br /> J <br /> � Toilet � � . rVC—air handling units <br /> � Balhtub '� � Forced air systems , <br /> � � Lavatory(wash hasin) . � Gas piping � � j <br /> � Shower �� � Waterheater j <br /> � Kitchen sink 8 disposal � Gas fireplace <br /> � Dishwasher � Gas range <br /> � Ctothes washer � Clothes dryer <br /> i � Laundry tray � Range hood ! <br /> � Sink (servicetb2dmopletc.) $ Exhausi fan TNl ;; <br /> , Backflow preventer Heat pump <br /> Urinal Unil healer <br /> � Drinking Fountain Boiler <br /> �' _ Floor drain Refrigeration I <br /> Grease trap Woodstove <br /> _ Ruof drains _ Other I <br /> _ Other _ I <br /> — — I <br /> CITY OF EVERETT LOCAL SALES TAX CO�E IS 7105 � <br /> I <br /> I hereby cerihfy that I have read and er.amined this application and know the same:o be true and correct. All provisions of laws and <br /> crdinaces goveming this type of�vork wiil be complied with whether specified herein or not.The granting o(a permit does not presume <br /> to give authoriry to violate or cancel the provision of any other state or local law regulating construction or the performance of <br /> construction. That I am authonzed b ' wner of;his property to peAcrm the werk(or which application is made and I comply with the <br /> Slate Con ractors Law 8 7 R ' a 9620 WAC. <br /> / —✓ <br /> i <br /> , Ignature of n�n ;Contra , uthorized Agent Date <br /> �(v! <br /> vC��3J�'/9 <br />