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P'�RMIT APPLICATI�N <br /> CITY OF EVERETT PERIVIIT SEF�VICES <br /> 3200 CEDAr� STREET, EVERETT, V'JA '�8201 <br /> 425-257-8810— FAX 425-257-f3857—www.everettwa.org <br /> APPLICATIOPIS ARE ACCEPTED FROM 8 AM TO 4 PM ��. �Gj�-�L/f S <br /> SITE ADDRESS PARCEL TIU:I.D.# PERMIT# <br /> ���0[- Z3'��� �'�� �.vC 5 � �� 225'� y -_� C�O/ - C,OC� ; � 1�05t1 `f.Cl� <br /> LEGAL 1.0T N0. BLOCK TRACT <br /> DESC. L� � <br /> OWNER ADDRESS CITY2IP PHONE <br /> ,a� ZO� J'L�J ' �S�'�' <br /> 5��1 �.iAy .-1.,JDu_5'��'�i1 [_ �sc'� c �vr s�r�;E.�O c,tAr�cE �s�i2� <br /> TENANT NAME CONTACT FOR PERMIT PHONE: <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> nct��w�,17 r�t c;���ti'��=AG, ii,'' C. �, �'. �;r'x 2v�i �crvc�2,4� <br /> CONTR.LICENSE# �. �,S J S��S � 7 �� <br /> �,!/�Ll�'Zr1„il�-� iin i ��'�/ <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> ._Electric �G, _Other <br /> WORK DESCRIPTION <br /> ����� " G� " ���/n���- �.�,��n�2��,��,ti�� sn�,�,��n2y w��s,� <br /> / Z w-,1 i Ci2 .s; u� <br /> PLJMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C–air handling units <br /> Bathlub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower _ Water heater <br /> Kilchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> Waler heater Range hood <br />� Sink (servicelbar/mop/etc.) Exhaust fan <br /> Backflow preventer Heal pump <br /> Urinal Unit healer <br /> Drinkinc� Fountain Boiler <br /> Floor drain Refrigeration <br /> Grease irap . Wcodstove <br /> Roof drains _ Other <br /> Other <br /> j — — <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceritify ihat I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be complied with whether specified herein or nol The granting of a permit does not presume <br /> to give aulhurity to violate or cancel the provision of any other stale or local law regulating construction or tht performance of <br /> conslruction.Thal I am aulhorized by the owner of this property to perform lhe work for which app�ication is made and I wmply with the <br /> State CoPtraclors Lav� 1827 RCW and 296.200 WAC. <br /> � " , ( �, (� � <br /> ��c-�1�1� ����1�)'1�L:�Ls')�ti� ll ' c' 7 GS <br /> Signatuie of Ow� dContractodAuthorized Ac�ent Date <br /> i�' <br />