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P��RMIT 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 <br /> SITE ADDRESS PARCEL TAl(I.D.�► PERMIT M <br /> I ,:ol ' ►2�3 k7�%�+�bA� hV� CJ�� b Z bo So SI � - l <br /> LEGA LOT N0. BLOCK CT ^ <br /> DESC. � -�j� vc-�wi � 3 � lC, If7J /Ti�O�Tic�/ <br /> OWNER ADDRESS CITY2IP PHONE a��� w^{f <br /> �o�� � ���ccc` �y4/a�1-I SY�75.uS �11� }�/Kii=�c �vFnuf 1`��ef77 �1�2�'� �`��,�7;�� �q z— <br /> TENANT NAME CONTACT FOR PERMIT � / PHONE <br /> �'�1�c �-I�t�,, It��- �`� �S� `�9 7� - G6 z'� <br /> CONTRACTOR ADDRESS ' 17Y21P PHONE <br /> /�1•�{� 111 o��s,rS4 r <t�.rrc y �`/7r y �{, ,�1 �� 1�vrc� ►�X�s✓u F , c.�.�/4 <br /> CONTR.LICENSEN y� �}1�1o2G � �yd�� �`�� � <br /> /�� " 1 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> I — — �6/Y£_ <br /> Electric Gas�Other <br /> WORKDESCRIPTION ��=���U �j( C � fSJ�//YC. jJI�1�L�[J� ����� <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toi�et A/C—air handling units <br /> Balhtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink 8 disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Laundry tray Range hood <br /> Sink(servicelbadmop/elc.) Exhaust tan <br /> Backflow preventer Heat pump <br /> Urinal Unit heater <br /> Drinking Founlain Boiler <br /> Floor drain Refrigeretion <br /> Grease trap Woodstove <br /> Roof drains Other <br /> Olher <br /> CIN OF EVERETT LOCAL SALES TA7(CODE IS 3105 <br /> I hereby ceritiy thal I have read and examined Ihis application and know ihe same to ha true and correct. All provisions of laws and <br /> ordinaces goveming this lypo o(work will be complied wilh whether specified herein or not.The granting of a permit does nol presume <br /> to givo authority lo violate or cancel lhe provision o(any other stale or local law regulating conslruction ar the pedortnance of <br /> cons!ruction.That I am authorized by the owner of this property to peAorm the work for which application is made and I comply wilh the <br /> �St te C ntractors Law 10. RCW and 296200 W 4C. <br /> 2� ��-- ' I� � �����°> <br /> gnature of OwneNCo tractodAuthonzed Agent � � at�� <br /> ��i� �{itz=c iZ <br /> 7�. nn'i <br />