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�. <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDP,R STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM � ..r-/ -j�� <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> i� ��� ��. ' c� � - svc�z�r -i <br /> !cGAL LOT NO. BLOCK TRACT OR SUBDIVISION S <br /> DESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> NA-�tcY NA�ca�o✓� soco v'��_o:.4��r.u7 �✓�, �1���3 �c�-s�,;-,��to <br /> TENANTNAME � CONTACTFORPERMIT PHONE <br /> � B�A.J �-4oc�Lt�r= tiz�_�7�-�Oyld� <br /> e-Ma� <br /> �� i i <br /> DA�r �-n�,� �L�xu�-. �- H r�r. I c��i�( 13,�.�.u.�- ta��r�l� uz���s=�yG� <br /> CONTR.LICENSE# Ol GI?J7 <br /> r�,a�v,�=P�Ruu � � �� <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> �Electric _Gas_Other � �'� ��J+�O <br /> WORKDESCRIPTION ���p��� �XI.Si7nY� �L�CTr�G F�'��`��E �� " """ <br /> �LIvriP �l�VIT'1-I /V2w' Ec-ECT1LlC ���-i-�'E .�-rt/D f-f�f1'tr <br /> Al,rr��P. 5A�'�� �aCA�C1u� , <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C air handling units <br /> Etathtub Forc ros <br /> Lavalory(wash basin) _ Gas piping <br /> Shower Water healer <br /> Kilchen sink 8 disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Cbthes washer Clothes dryer <br /> Waler heater Range hood <br /> Sink(service/badmop/etcJ Exhaust tan <br /> Back(low preventer = Heat pump <br /> Urinal Unil heater <br /> Drinking Founlain _ Boiler <br /> Floor drain Refrigeration <br /> Grease lrap _ Woodstove <br /> Roo(drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y thal I have read and examined this application and know the same to be irue and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied wilh whether specified herein or nol.The granting of a permit does not presume <br /> to give authorily to violate or cancel the provision of any olher slate or local law regulating construction or lhe performance of <br /> conslruction.That I am aulhorized by the owner of this property to perform the work for which applicalion is made and I comply with lhe <br /> Slate Cont tors Law 18.27 W an 0 WAC. <br /> �,�_ � • �� ;� �-�-G S'� <br /> Signalure oi nedConlractod ulh ri e gen Date <br />