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PERMIT APPLICATIUN <br /> CITY OF EVERETT PERMIT SERVICES � _6 � 07 <br /> 3200 CEDAR STREET, EVERETT, WA 98^01 <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM B AM TO 4 PM �(/� �U� � <br /> SITE ADDRESS PARCEL TAX I.D.# �Ml�jo� 1 C„ <br /> 21 v0'395� OObOSS"- 0 - �Ul - d6 / c� <br /> LEGAL L,O NO\ .BLOCK TRACT OR SUBDIVISION# N � S o - <br /> ItAu1'�e SAI <br /> DESC. / 2 I � �-- iz _ o�l SP r2oz- o _o _ <br /> OWNER �� AODRE S CI P <br /> CE�Lr-�,s� �,�nzJ�z��� 1�,�. �.� .�x 3oos �rr qaz�3 3�b��s <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> �. . ., � CP,t3 C�Lec��SaJ , . �z�. ��J�S_ ZtjdS—•. . ., <br /> �, z <br /> CONTRACTOR + ADDRESS CITYlZIP PHONE <br /> G EuFr��,,J awrnah w�1 ��c. .�.�,a� �wr �-r.�zr . qQu3 ,y�s';3�f6-zyos- <br /> CONTR.LICENSE# �� '� � ! " <br /> Gsc��c.�o4 9��tt <br /> USE OF BUILDING HEAT SOURCE �CONTRACT PRICE OF WORK <br /> S L� �'f�'��1 ��J�'f.��� _Eleclric �Gas_Olher I$�(' OQ(�,� <br /> WORK DESCRIPTI N N�tI uOIAC Z�,S' � �I" �j P�'L+�CfF �I�O .I� <br /> PLUMBING MECHANICAL <br /> NO. TYP[OF FIXTURE OR ITEM NO. NPE OF FIXTURE OR ITEM <br /> ,� Toilel A/C-air handling unils <br /> 2� Bathtub 1 Forced air systems <br /> � Lavalory(wash basin) ; -T�h Gas piping <br /> 1 Shower � Walerhealer <br /> � Kitchen sink&disposal � Gas fireplace � <br /> � Dishwasher 1 Gasran�e <br /> � Cbthas washer � Clothes dryer <br /> Waler nealer �_ Range hood <br /> ^ Sink(service/badmop/etc.) _� Exhausl fan ;Jj' <br /> Backflow prevenler Hea�pump <br /> Urinal Unil healer <br /> Drinkiny Founlain Boiler <br /> Floor drain . Re(rigeration <br /> Grease lrap . Woodslove <br /> Rool drains Other <br /> � Other <br /> CITY OF EV[RETT IOCAL SALES TAl(CODE IS 3105 <br /> 1 hereby ceritify lhal I have read and examined this application and know�he same to be true and correcL All provisions o(laws and <br /> ordinaces�oveming this type o(work will be complied wilh whether speci(ied herein or noL The granting of a permit does nol presume <br /> to give aulhonry lo vinlTle or cancel the provision of any olher state or local law regulating con;truction or the peAormance of <br /> conslruction.That I am authorized by the owner of lhis property to perform lhe work for which applicalion is made and I compiy wilh the <br /> Slate Contraclors Law 18.27 RCW and 296.200 WAC. <br /> � .,c�z.�l� � lb -0� <br /> Si�naWre ot OvmedContractor/Aulhorized Agent Date ,��. <br /> �- � <br /> �1 �: -' � ��j � �Iz <br />