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PE. :MIT APPLiCATl4�� � <br /> CITY O�' EVERET'T PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 I <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org ���� �^,��; _� � I� <br /> , APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED I <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> s� .:� �� �`� sr � � �z �o S- �o� �� o�� s . o <br /> ��- � <br />' ��� LEGA LOTNO. BIOCK TRACT <br />. .'m,�l�! Y' ' � <br /> ;�''i DESC. J /� <br />� .�IS�?s ' . .7 � ' � 4 <br /> r%y'4 -_';, OWNLR ADD ESS qTYIZIP PHGNE <br /> . <br /> 36v -3 `f/-�fGo�f <br /> `'� _ ' /�� O /�c��G�zee.d'�-C C �%G�.•,I 1��� �' !�ti��, Gc,�� `%s-s' � <br /> TENANT NAME CONTACT FOR PE�MIT PHONE <br /> �P 1��o�G.7 "i'2,f uzz _oS77 <br /> v3 �G a- 9z <br /> J�-•-»�,-, l9-�� 9 -f�V 33 <br /> 0 <br /> C NTRACTOR ADDRESS CITYIZIP PHONE <br /> r s�o �',<-� Gu.�-.�LL c <br /> CONTR.LICENSE# � p <br /> j"�t �l�.�-/o ; </I ���O,o�l" 9/G C��� 4J2 9�23 [: 3GG-3 •�'/ -4�L- o`1 <br /> USE OF BUILDING HEAT SOURCE CONTRACT FRICE:OF WORK <br /> ��u� � �� X ) J� _Electric �Gas_Other � <br /> �v 2,: .v-r��e. .-, �7 U LJ O <br /> � � <br /> WORK DESCRIPTION <br /> � � <br /> /(�� ��� f� , <br /> PLUMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR ITEM <br /> � Toilet A/C-air handling units <br /> -Z Bathtub � Forced air systems <br /> � Lavatory (wash basin) %� Gas piping <br /> Shower � Water heater <br /> / Kitchen sink&disposal Gas fireplace <br /> � Dishwasher � Gas range <br /> _L Clothes washer � Clothes dryer <br /> _ Laundry tray Range hood <br /> Sink(service/bar/mop/etc.) ' i Exhaust fan <br /> .� Backflow preventer Heat pump <br /> I i _ Urinal _ Unit heater <br /> Drinking Fountain Boiler <br /> � Fioor drain _ Refrigeration <br />��''� ' , _ Grease Vap Woodstove <br /> Roof drains Other <br /> � Other <br />��'. i., _.� , — <br />� — <br />(`: <br /> • CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> II hereby ceritify that I have read acd examined this application and know the same to be true ard correcL All provisions of laws and <br /> ordinaces goveming this type of work will be complied with whether specified herein or not The granting of a permit does not presume <br /> I to give authoriry to violate or cancel the provision of any other state or local law regulating constructlon or the performance of <br /> construction. That I am authorized by the owner of this property to perfcrm the work for which application is made and I compty with the <br /> � State Contr tors La v 18.27 RCW and 296200 WAC. <br /> 9�''t��r✓'��i ,� -��- o S <br /> Signature of OwnedContractodAuthorized Agent Date <br /> I�v <br />