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( � I <br /> PERMIT APPLICATION !, <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, E�'�RETT,WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �O a,a.� <br /> SITE ADDRESS ` PARCEL TAX I.D.# yPERMIT A� Z <br /> IliJl� lI��. Q�. S1�i' C101111�.11UC00�� ()�J 1 � � �(��1�—USJ <br /> LEGA LOT N0. BLOCK TRACT OR SUBDIVISION N <br /> DESC. <br /> OWNER ADDRESS CITYIZJP PHONE <br /> j`SC'� Z �� �5`� �U3t� �lf�i� � l .(J W �� J2tZ�F I� J�G � ���.5 '�u5 " 13� -1 <br /> TENANTNAMF I CONTACTFORPERMIT PHONE L'Z5-_ � ��7- ��1i�I <br /> ��"h ��.yi�., <br /> E-MPJLIf.FoQW�Y�G1 �t�� h�•5 �-G�^1� <br /> ��f� �� ` PHONE { <br /> ��y 'T7.��, F ylC�"�'� �1a�l,t;'..' ���.J ' ����' 1� ��� <br /> �,,��,;� ,.� t<.:, �1�.<� c ,.\ F,�.S :�(, �'� ��I �.,� ,,.� I <br /> CONTR.LI�ENSE K <br /> i.�)�� l-\ i+VC�� 1 � LS7 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Electric �Gas_Olher � Y G �- ' � 7 <br /> WORKDESCRIPTION �2��c,.c? �y.•St�.•.� 'd � ��S vC'..C.�•' �-1 ,��. `�Zw �L ° �o 1- � lec,�� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OP FIXTURE OR ITEM NO. TYPE OF FI�URE OR ITEM <br /> Toilet A/C–air handling units <br /> Bathtub � Forced air syslems <br /> Lavatory(wash basin) _ Gas piping <br /> Shower _ Water heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher _ Gasrange <br /> Clothes washer _ Clothes drye:r <br /> Waterheater _ Range h000 <br /> Sink(service/barlmopletc.) _ Exhaust fan <br /> Backflow preventer _ Heat pump <br /> Urinal _ Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain _ Refrigeration <br /> Grease trap Woodslove <br /> Roof drains _ Olher <br /> Other — <br /> CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> I hereby certify that I have read and ezamined this application and know the same to be true and wrtecl. All provisions of laws and <br /> ordinarces governing this type o(work will he complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authoriry to violate or cancel the provision of any olher slale or local law regulaling construclion or lhe performance ot <br /> construction.That I am authorized t�y lhe owner oi this property to perform the work(or which applicalion is made and I comply wilh the <br /> Slate Conlractors Law 18.27 RCW-and .�WAC. , <br /> � ,. <br /> �� _�=�G-�--=` /c��� I 11 �� <br /> SignaWre ol OwnedContracrorlAuthonzed Agent Da�— <br />