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P �RNIIT AF'PLICATl�,�J l <br /> CITY OF EVERETT PERMIT S�kVICES <br /> 3200 CEDAR STREET, EVERETT, WA 99201 <br /> 425-257-8810— FAX 425-257-8857 —www.evereltwa.org <br /> APPLICATIO�IS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS y- PARCEL TAX I.D,t� PERMIT u <br /> 1 l C�f �l 5 �,T f J��1�-t/� oo s9 �a-aa 3aa �oz ���-`��� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS GITY2IP PHONE <br /> f V�c��,��-ti S 11 v�,z� <br /> TENANTNAME I CONTACTFORPERMIT ^HONE <br /> E•MAIL. <br /> CONTRACTOR �(!.r � -•�.���ti �.[.ka=aw RESS � `� CITYIZIP�y.,,��/�� �(/��PHONE,/�c– -�� A�d"� <br /> �Itl�l/.c'�c'l"kYf� `�W '' <br /> CONTR. LICENSE# �fJCy��/YLUIJ 7D I <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Electric �Gas_Other �� <br /> WORK DESCRIPTIOh. .-�' <br /> �,`'J t i 1� �/La�-��� <br /> �-��z�� � � I <br /> � - <br /> PLl1MBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF fIXTURE OR ITEM <br /> --- ���;i�„� A�C--air handlinc� units <br /> 6alhlub Forced air syslems <br /> Lavatory (wash basin) . 1 Gas piping <br /> Shower _ W�derhealer <br /> Kilchen sink&disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Cblhes washer _ Cblhes dryer <br /> Waler healer __ Range hood <br /> Sink(service/barhnop/elc.) _ Exhaust fan <br /> 6ack�low prevenler __ Heal pump <br /> Urinal _ Unit healer <br /> Drinking Fountain _ Boiler <br /> Floor drain _ Re(rigeretion I <br /> Grease lrap __ Woodstove i <br /> Roo(drains _ Olher �I <br /> Olher _ — <br /> i — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y thal I have read and examined lhis applicaGon and know the same lo be true and correcL All provisions of laws and <br /> ordinaces c�oveming lhis lype o(worh will be complied wilh whelher specitied herein or noL The granling o(a permil does not presume <br /> to giv_c authoriry t!N violate or canr.el the provision of 2ny o�her state or local law regulating consWclion or the pedormance of <br /> construdion.Thal I am authurized by lhe owner of lhis property lo perform lhe work for which application is made and I comply wilh lhe <br /> Sla}e C ntractor��l.'�3w�}f1.27 6W i 296.200 WNC. <br /> / / <br /> � G �� ' (/����r� �.� <br /> SignaWre o wner Conlractor/Authorized y ��� <br />