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w25.:-`�',.. � <br /> 1Y.�' ._ ___ <br /> T.�.'�. _____—_� <br />"�" P�tRMIT APPLICATIG��1 <br />.:,�. <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 /> _ APPLIC�,TIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT & CREDIT CARDS ARE�T ACCE LED <br /> � SI7E ADDRESS � PARCEL TAX LD. # FEP.MIT# <br /> I' �o � �6 � 5T, 3L�b53U�tt�o�� � ��7-1�23 <br /> LEGALI LOT NO. � BLOCK TRACT <br /> DES�'.T � Sf <br /> i <br /> OWNER ADDRESS C1N/ZIP PHONE � - <br /> ,4�� U P.9,�?� �/f'�E/r .CLc o :�co - s u,_. ,; . ., <br /> -- — �,C��l;%o C�i��/f�v l�f, _ %��3� <br /> TENANT NA7dE CONTACT FOR PERA7IT PHONE <br /> - .- I ,,�i�� ' �oh'�F �•' � �2� �-Z2 - c� 8 ?!� <br /> C NTRACTO CITY:ZIF' P ONE '� <br /> � �.)��' ��/-"�!/f" L i ivi i�I--�l ADORESS , ,3 �Q.-J�f/- <br /> <rE a r <br /> � CONTR.LICENSE p � � • • <br /> P�r�,��� � o iz.�� ��° �o �y�,, �.� ��v��� 4i,s- y�' z�� <br /> USE OF BUILDING HEAT SOURCE <br /> i — L I — — CONTRACT PRICE �F WORK <br /> S�^�u.0 E / �'�"' � Electric X Gas Other I/� � G G� <br /> = � 2/0RK DESCRIPTION r ' -- <br />;`�:,^`-,; <br />�q <br /> a�f:4; <br />_ � � �.i s 7`/k c fiv�v n �' N�� 5"��✓�< r- �',y�,.,. /y � wc'i/,��� <br /> A, . <br />*�s <br /> rr�.� � ; � <br />�'"�� PLUMBING `�� �� C � <br /> �.'� MECHANICAL � � <br />-�5'� ����� TYPE OF FIXTURE OR ITEM <br /> 5'`.� N�'� TYPE OF FIXTURE OR ITEM <br />' `- � l oilet A/C-air handling units <br /> 6athwb <br /> i '<— � Forced air systems <br /> I J Lavatory (wash basin) Gas piping <br /> Shower Water heater <br /> � Kitchen sink 8 disposal � Gas fireplace <br /> Dishwasher I Gas rahge <br />;;�, ; i I Clothes washer � Clothes dryer <br />�-ti=��.�� / Laundry tray Range hood <br />'���� Sink (servicelbar/mop/etc.) <br /> ii,- _ Backflow preverner � Exhaust fan <br />!''� ` Urinal _ Heatpump <br /> ` " — Unit heater <br /> _ Drinking Fountain Boiler <br /> __ Fleor drain Refrigeration <br /> _ Grea�e trap — <br /> Roof drains _ Woodstove <br /> Other _ Other__ <br /> I I — <br /> __ CITY OF EVERETT LOCAL SALES TAX CODE IS 9105 <br /> ���.ereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ..:c;naces 9overning this rype of work will be complied with whethEr specified herein or not. The granting of a pe�mit does not presume <br /> ;�.: ;,ve authcrity to violate or cancel the provision ot any other state or local law regulating construction or the per(o:mance of <br /> :.��nstruction. That I am authorized by the owner o(this property to perform the work for which application is made and I comply�:�;i!h ;ne <br /> State Contractors Law 12.27 RCW and 256.200 WAC. <br /> // �� , , • � i � - <br /> 3.;nature o(Owner/Contractor/Authorized Agent Date ( ,� <br /> \�� <br /> --- <br /> _-__ -. -- - .4 <br /> .._,.. _ . . � <br /> �.s.^-:.. - - - :� . � . -T•�� � ' -._--- -. ..._.._. . . - � _ <br /> , - _ . <br /> „ _, <br /> ...-- --='- -_` <br /> --���`-. �,::.----. ._ ' --_��. -- - - -"-- --- � -`--"-=— -. -"° � - -""°"'. <br />