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P�RMIT APPLICAT9GN <br /> CITY OF EVERETT PERMIT SERVICES ,�(Q � <br /> 3200 CEDAR STREET, EVERETT, WA 98201 i��� <br /> 425-257-8810 – FAX 425-257-8857–www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOl'ACCEPTED <br /> . . .�., — <br /> SITE ADDRESS �. .% / �,.,-' ..:7 i ��- PARCEL TAX I.D.# PER T# <br /> ` � 3129�5 00 5�600 -J`C�{�� <br /> , <br /> LEGAL LOT NO. BLOCK TRACT <br /> DESC. '�� f . CAI�'IQF/�L � <br /> OWNER AODRESS CITY/ZIP PHONE <br /> _/? � r� Pr�,�k _r. �a��� �< <c c P,a.,�ox 9io Cci.vro�98;�3� �6o•3y/- y6oy <br /> TENANTNAME I CONTACTFORPERMIT PHONE <br /> �CNTRACTOR ADDRESS CITYIZIP PHONE <br /> �.4'U. PAh'ltC�'�'�k � � C � <br /> CONTR.LICENSE# <br /> �fJ rk('L'.F011LI� �D�aDXgID �'L(NIdN `IS�;i3G 3�o--3'Y/-`/60`/ _ i � <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Elechic Gas_Other I! <br /> .Si�t/_G-Lf Ffl/�r�L bw�LLI�vG- — �- �!y o00 , <br /> WORK DESCRIPTION � D <br /> � , i \���Q � �� i i <br /> _L l ' <br />��4� � Cv,(/S%� G/G fI Sl�f/GL � 1-/�/�/L DcvfLLlN V � ��.�_.�:� i <br /> , � PLUMBING ��t+t CHANICAL � <br /> -.� ,.� � �� <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR I � �'�I I I <br /> i �t i <br /> � Toilet A/C-air handlinc� units r j� �, ! <br /> ;� Balhtub Forced air systems i�� �� <br /> �7 Lavalory(wash basin) � Gas piping _ \(,�� , � <br /> Shower �_ Waterheater i (((��� � ', <br /> � Kitchen sink& disposal _L Gas tireplace `y1 ` /`� s{ <br /> � Dishwasher � Gas renge �I �J Il <br /> _� Clolhes washer � Clothes dryer � <br /> _ Laundry tray Range hood i V <br /> _ Sink(service/badmop/etc.) � Exhaust fa�, � �� �. <br /> _ BackOow prevenler Heat pumo ; fi <br /> _ Urinal Unit heater �� � Fi <br /> Drinkln� Fountain Boiler �;, �� � <br /> �_ Floor drein Retrigeration } �yi <br /> _ Grease Uap Woodstove <br /> Root drains Olher <br /> I _ Other = �P <br /> �. <br /> _ �. <br /> CITY OF EVERETT LOCAI SALES TAJ(CODE IS J105 F'= <br /> I hereby ceritify thal I have read and examined ihis application and know the same to be Vue and correct. All provisions of laws and !` <br /> ordinaces governing lhis rype of work will be complied wilh whether speci(ied herein or noL The granting of a permit does not presume ? <br /> lo give aulhority to violate or cancel lhe provision of any other state or local law regulaling construction or lhe per(ormance of <br /> construction.That I am authorized by the owner of this properly to perform the work for which application is made and I comply with the <br /> State Contractors Law 18.27 RCW and 296.200 WAC. ��� � <br /> ��,v�,/,�, c,��--- y-�7- ��s— l '�V <br /> S nature df Uwner/ContractodAulhonzed Agent Date C b u �(� I <br /> J \ �( <br /> q <br /> i; <br /> 4 <br /> - � <br />