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� , <br />��` :�1 <br />� _ <,� <br />' �� � P�.RiVIIT APPLICATIC�nI <br />,� ,; ; <br /> i ..�tr'(.,:� <br />�;;�:<;�; CITY OF EVERETT PERMIT SERVICES <br /> ' `�'" `'�� 3200 CEDAR STREET, EVERETT, N/A 98201 <br />��� 425-257-8810- FAX 425-257-5857-www.everettwa.org �l � � _ .,n <br /> .5�� <br />� �' ' _ APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> 1 �. <br /> j ` SITE ADDRESS PARCEL TAX I.D.# PERMIT� <br /> '.,, �r� (�—j <br />� � �� / ��i �SfSF G/�/ 5��v000 �voo �� W � � I / <br />�;;�<: �, � LEGP.L LOT NO. BLOCK TRACT <br /> DESC. 2 U �/����_� � <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> ��b /��G,�rO, C�c ��D/�.�r �ia , G��=-�� ,/ � 9� zT6 5�zs•aT� � zz v <br /> TENANTNAME � CONTA'�C/TFORPERMI� PHONE <br /> 5��- � I ' 1� /"d �fE�C v7`.,-TTSb"te yc <br /> CONTRACTOR �QQ ��� (��LC� AD�RESS CITY/ZIP PHONE <br /> U/� � "� <br /> CONTR.LICENSE# �/ J � �lU �--���T; cGe�- <br /> �R�Q�' l � '� D/Z t/� 7SZ�S �LS 'Z.rfr- b'z'r � � <br /> USE OF BUILDING I — HEAT SOURCE I CONTRACT PRICE OF WORK �i <br /> 5���� �a-��•< �����,�,�.,.� ElecMc �Gas Other ���� v <br /> WORK DESCRIPTION �S <br /> $ <br /> iII�J 5�;,4 ,ca��T� ; <br /> �; <br /> � . C-i i" <br /> PLUMBING MECHANICAL `i <br /> NO. IYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM : <br /> J Toilet � <br /> A/C-air handling units 4 <br /> � Bathtub � Forced air systems � <br /> Lavatory(wash basin) � Gas piping <br /> � Shower ! Water heater <br /> / Kitchen sink&disposal / Gas fireplace <br /> T �ishwasher �_ Gas range � <br /> 1_ Clothes washer / Clothes dryer � <br /> _ Laundry trey � Range hood j� <br /> Sink(service/badmop/etc.) ��_ Exhaust fan �, <br /> 1_ Backflow preventer _ Heat pump <br /> _ Urinal Unit heater � <br /> _ Drinking Fountain Boiler <br /> _ Floor drain Refrigeration " <br /> _ Grease trap _ Woodstove �; <br /> Roof drains Other <br /> � _ Other — <br /> CITY QF EVERETT LOCAL SALES TAX CODE IS 3105 i <br /> iI hereby ceriti(y that I have read and examined this application and know the same to be true and correct. All orovisions of laws and � <br /> ordinaces goveming this type of work�.vill be complied with whether specified herein or not. The grenting of a permit does not presume <br /> to give authonry to vioiate or cancel the provision of any olher state or local law regulating construction or the performance of <br /> construction. That I am authorized by the owner of this property to pertorm the work for which application is made and I comply•�vith the <br /> State Contractors La 18.27 RCIN and 296.200 WAC. ' <br /> I ��l�r��C G�� � —?7- aJ� f. <br /> Signature of OwnenContractonAuthorized Agent Date 4 <br /> � �� I <br />