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�. <br /> P�RMfT APPLICe4TIUN <br /> CITY OF EVERETT PERMIT SERVICES <br /> 320J CEDAR STREET, EVERETT, WA 98201 / <br /> I 425-257-8810- FAX 425-257-8857-www.everettwa.org �� � <br /> �cv�- <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADORESS PARCEL TAX I.D.# PERMIT# � <br /> �i� �� » ,�s� � ,�, �� �� � o zz o0 o�b - v� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. Z Z CIMTF/( [ � <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> /�4'L� ✓��Gz�r-.�/�G< �/ G Jn Y/J ��..-� G✓� y�z.?�' S� zr- z�:= 8 za X <br /> TENANTNAME CONTACTFORPERMIT � PHONE <br /> S��C �G�J E�� /vd /�fi',�' 'f 2 S�- 2 T 8 8 � x .c <br /> CONTRACTOR /Q¢,O �Nz�(�r-cr� L�C A�DRESS CITY2IP PHOME <br /> CONpTR.LICENSE# � <br /> _1 ���"CL .� o/ Zc ? ��%f `1/�� (�,��,�;����-c �j� zJ! �ir z .�8 "a- zz � �. <br /> � <br /> USE OF BUILDING HFAT SOURCE CONTRACT PRICE OF WORK <br /> � �'�";� ,��•�� �Q��r'��`� _Electric �Gas_Other � �,� � v v ��'� <br /> / <br /> WORK DESCRIPTION I <br /> , � <br /> ��/�,�, i�,�.e Fa�.,.f d_�,�;`` =�� I � I ; ;�j I <br /> P��N i�- � I <br /> PLUMBING MEGHANICAL <br /> NO. 7YPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> 3 Toilet A/C-air handling uni!s <br /> � Bathtub �- Forced air systems <br /> `'�_ Lavatory (wash basin) ?� �as piping <br /> y Shower � Waterheater <br /> / Kitchen sink 8 disposal / Gas fireplace <br /> � Dishwasher / Gas range � <br /> � Clothes washer � �lothes dryer <br /> _ Laundry tray Range hood <br /> Sink (service/badmop/etc.j � Exhaust fan <br /> �_ Backflow preventer Heat pump <br /> Urinal Unit heater <br /> I _ Drinking Fountain _ Boiler <br /> I _ Floor drain _ Refrigeration <br /> Grease trap Woodslove <br /> Roof drains Other <br /> Other <br /> iCITY OF EVERETT LOCAL SA�ES SAX CO�E IS 3105 <br /> � I hereby ceritify that I have read and examined lhis application and know the same to be true and correct. All provisions of laws and <br /> � ordinaces governing this type of woik will be complied wilh whether specified herein or not. The granting of a permit does not presume <br /> Ito give authonty to violate or cancel the provision of any other state or local law regulating consWctlon or the performance of i <br /> construct��n.That I am authorized by the owner of this property to perform the work for which application is made and I comply with the <br /> State Cont-a ors Law 'I827 RCW and 296200 WAC. <br /> � ���,�,���".-`e��— G - <�-�r <br /> Signature of OwnedContractonAuthorized Agent Date I <br /> I - I�-- <br />