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P�tRMIT APPLICATIt,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 /> � -��,-o.� <br /> APPLICATIONS ARE ACCEPTED fROM 8 AM TO 4 PM -DEBIT R CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.N F RMIT� .� � <br /> �/��/J ��i i.�/G�v ll/rj �/ LX�S�/v7 9'-C7D l-CL�l-O/ �(�` '- I <br /> DESQ LOiNO. BLOCK �TRAC7 �r�;�� �r-b �N V��cc/n�� Jl G�' f�� �7��� <br /> OWNER 7 r� ' ��= L4- �tuC' DS' t=F �Ni� iSt1 CCN�vT� �v� <br /> S�-AJ�i-k�N.-iqi/73ADDRESS CITY2IP PHONE <br /> >>1AIL�� � y'?- �ys-7S$ � <br /> r 9 TN��Ffi- �cG���-^�� y�2'i � Sc�F�'r��: �,�.�.}Y� �Z'C��i ��•.= �t b'z� 3 <br /> TENANT NAME CONTACT FOR PERMIT <br /> PHONE <br /> Sr,''i�'!�/�.7 C"�Z 7Nt-'»7fS •!�'7 Z :a�-�:� S / <br /> %C c����..��� <br /> CONTRACTOR ,���;I', .,'.1� ... ,,,,.._..,; , ADDkBSS CITY2iP PHONE <br /> ��.� , , ,..�;.y cl �-' , <br /> CONTR.LICENSE k � ��� � 7'� �`�C��� �' <br /> ! � <br /> � ., . ' /C'_ � `-1�:, 3 / f- (l <br /> ; �,�•-r,1J - ^r� ,: v /o-�a - o <br /> USE OF BUILDING p HEAT SOURCE CONTRACT PRICE OF WORK <br /> !y�Ui�/�i[��1: 7"�2% r?I>��l/L�/ I �i✓��-T/ $b' GZ�7 t-- ` <br /> ✓ ElecMc Gas Other � <br /> ,e?��Zri+� — — — °�l�D �/t� t`�z.'L' � - <br /> WORK DESCRIPTION <br /> r_7cT��.J[�i/.'c_� T�Yi+-t� L� ��c:`�-i•-r Gtt% 6 �z�� _ c7c��.^AiA.'�-� <br /> �'c'1.'�7-'�_'y� i'C�-'._ rt .'9��.c7 ��t.l.j-i�'�, in:c� Di�-�c�'77G'��: <%`F' �c.7VT <br /> :�-7='c <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TVPE OF FIICTURE OR ITEM <br /> _ Toilel A/C-air handling units <br /> _ BathWb � Forced atr systems <br /> _ Lavatory(wash basin) Gas i m <br /> PP 9 <br /> _ Shower Water heater <br /> _ Kilchen sink&disposal Gas fireplace <br /> _ Dishwasher Gas range <br /> _ Clothes washer Clothes dryer <br /> _ Laundry tray Range hood <br /> _ Sink;scvice/ba7mop/etcJ Exhauslfan <br /> _ Dackllow piovr;der Heat pump <br /> _ Unnai Unit heater <br /> Drinking Focntain Boiler <br /> _ Floor drain Refrigeration <br /> _ Grease trap Woodstove <br /> _ Roof drains Olher <br /> Olher — <br /> — N6h.c ✓ !?�i}_"s.liJ/AJlq <br /> / _�r_'T_ ✓t-�)T:5 <br /> jT� �I�h/ Lti/)",L <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify that I have read and examined this application and know the same to be true and correct. All pro�•isions of laws and <br /> ordinaces governing this lype of work will be complied wi�h whether specified herein or not.The granling of a permit does not presume <br /> to givr,authonty to violate or cancel the provision of any other state or Iocai law regulating construction or the performance o( <br /> conshuction.That I am authorized by the ovmer of this property to pertorm the v.rork for which appiication is made and 1 comply wilh the <br /> Siate Contractors Law 18.27 RCW and 296200 WAC. <br /> _�J ��('Jt�" ��-1 �V ��9>c�l��. ��/'��U.�- <br /> Signa ure of Owner/Contractor/Authon ed Agent Date �/ <br /> a <br /> � <br />