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,. , <br /> P`�RMIT APPLICATI(�N <br /> CITY OF EVERETT PERMIT SEK'v'!CES C o G o:� -03 <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810-FAX 425-257-8857-www.everettwa.org �I _�..�_�� <br /> APPLICATIONS P.RE ACCEPTED {'ROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# P�RMIT# <br /> c7 �5� //J�7°mo,� t. /�vc-h �t.z U0.3 � 7�i27D� �_ ,o� `� , <br /> �EGAL 1.0T NO7. r— BLOCK TR T , / �G y/y/� <br /> DESC. �_7 "�'/�S� /�� � O /L' f c"c� �v ,!1/G'�t.' // <br /> OWNER / ADDRESS CITY2IP PHON ��pb�-]�)-oy)" <br /> /` ' <br /> �^�/_i= 2 �� �/�-�'�/( ���r� � �°pr� �✓� f�' ,li,.��o��,s , �Sia) !� �/.17 <br /> TENANTI7AME /CONTACTFORPERMI/T / i`HQNE <br /> � /t���l '� C�l irx /"/'�c h c,C�" ( 2J-.t � er'.Z � - 51-s�' <br /> CONTRACTOR ADDRESS CINIZIP PHONE <br /> ��.�/h� ✓` <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> � �JG:.�� ��FYf�i . �If•�14�L'- �� OA� <br /> �s ����, �2 L � _Electric L�Gas_other �j,��,�/J <br /> WOpRK DESCRIP7ION ,��f j S�'�' �F k�, f-, �it • �;r.:� ' �/ � <br /> /\r_ir� o.�t ( /co� s� �C1i:�t..i � w� ( ��('' _. .1 <�'I ^� <br /> , '7 <br /> J1'e1N,.^G � /�'G�+�..wt�j �t�il�L Cci\✓G�� f� /V�j'cc✓�f ��i1. �,�� K ��� �,�'`'�'/ <br /> ��,/��. /J�-�!/ Y�� .fF/= �t.! 4[,/l f.� r�2 �4., J_ . >� . !1�` ���, �i/ <br /> i <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilef A�'C-air handling unils <br /> � Dathtub = Frced air systems <br /> � Lavatory pvash basin) � 3as piping <br /> Sho�ver � V��aler heater <br /> � Kilchen sink&disposal � Gas fireplace <br /> _� Dishwasher � Gasrange <br /> � Clolhes washer � Clolhes dryer <br /> �' Waler heater � Range hood <br /> Sink(serviceNar/moplelc.) Exhaust fan <br /> Back(low preventer _ Heat pump <br /> Urinal _ Unit heater <br /> Dnnkin� Fountain _ Boilcr <br /> Floor drain Refrigeration <br /> Grease lrap _ Woodstove <br /> Rouf drains Olher <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS J705 <br /> I hereby cerilify that I have read and examined Ihis application and know Ihe same�o be true anu correct. All provisions ot laws and <br /> ordinaces goveming Ihis lype o(work will bc complied with whether specified herein or nol.The c�ranlinc�ot a pemiit does not presume <br /> to�ive aulhority lo violale or cancel Ihe piovi:ion o(any olher slale or local law regulating construclion or the per(ormance of <br /> conslruclion,That I am aulhorized by Ihe owmr ol this property to perform the wor!e for which applica�iun is made and�compty wilh the <br /> Slale Conlractors Law 18.27 RCW and 29620�WAC. <br /> � i' <br /> /��; ��� ����� /�/d- O.(. <br /> �T <br /> Sign ture of Ow� er/ConlraclodAuthonzed Agent Da�e <br /> �IN <br />