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�ERMIT APPLICATIUN <br /> CITY OF EVERETT P�RMIT SERVIC�S <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX a25-257-8857 -www.everettv;a.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS F��1-�S'�q�`�" � 7 PARCEL TAX I.D.0 ,�1 P�1ERMIT N <br /> � i 3-a- I S,�u���nr.� +2r� 8'oS 14�00 �-�l 02'� oc� I►'` ��� �=r— <br /> LEGA LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> C�z� ��- Lv �n.cr- 3�vo �'cnnn.ST E�c.-tic--�� �`L 'ial_ 4?-S- a..S7 - 89 �1 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �2zN� t� ,+M �ZS3) 8sy- a � �� <br /> CONTRACTOR AODRESS � g17Y21P PHONE <br /> DC-S�La�+ � �n. �T,� �y' G�> '1 .`Jo�.� i-"r 11 :J" � 6CC-uC�l.t.�r} 'L�� 3 ' �5`� <br /> � 9 ��3i -�Li� Z�� J <br /> CONTR.LIC SE M �1- <br /> �GSIvL ,�110G <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �` 2�_ S ���'�'-� _Electric _Gas_Olher �.3 2- �� 1 �, � o `-' <br /> WORK DESCRIPTION � � �x « � �7.� �x;n,r�L;'�,�, <br /> ;'� .�.� U C- 1�Cc. v L�-F� L.�. <br /> � Al J��h��. /a �7 ` U L� L✓ 1-E �.-�-� � v C' � <br /> J_I'J�1 L'�"'1 T� I�.L. � �-C.l � <br /> PLUMBING MECHANICAL <br /> MO. NPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C-air hand�ing units <br /> Bathtub Forced air syslems <br /> Lavatoq�(wash basin) _ Gas piping <br /> Shower W ater heater <br /> Kitchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gasrange <br /> Cbthes washer Cbthes dryer <br /> Waler healer Range hood <br /> Sink(servicePoar/mop/etc.) _ Exhausl lan <br /> Dackflow prevenler _ Heal pump <br /> Urinal Unit heater <br /> Drinkinc�Founlain Boilor <br /> Floor drain Refrigeration <br /> Grease lrap \Noodsloye Gx H��• t <br /> Roof drains r� Other V<_•-`� ���- <br /> OIhC� S`> > �i Gw <br /> Ci fY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerilify ihat I have read and examined Ihis application 2�d kno�v lhe same ro be true and correcL All pmvisions o(laws and <br /> ardinaces governing this type of work will be complied with�•hether specified hemin or nnt The granting of a permit does not presume <br /> to give aulhonly lo violate or c�ncel the provision of any other stalr.cr local law requlalieg construc[ion or the pedormance o( <br /> construclion.Thal I am aulhorized by Ihe owner o(this properly i� �edorm the work for which application is made and I comply with the <br /> Slate Conlractors Law 18.27 RCW and 296.200 WAC. ��� <br /> !� �z 6�/`P" <br /> Siynalure o(OwnedConlraclodAuthonzed Agenl Date <br />