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i � — <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR 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 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> ��lvl �?S'�`` �(Uz I,J o� 35Udnc� c��o� 1003 v� <br /> LEGA LO7 NO. BLOCK TRACT OR SUBDIVISION p <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> '���;icL �� t�c � � yU� ��5 .� ��� � �✓��a� y1.5— �.��-lrY`/j <br /> TENANTNAME CONTACTFORPERMIT PHONE��,� ;z�, � � ����� i,` f, �,7 <br /> 1 g � � <br /> J�-..v,GC ��?[;,cN,- �'/� ��rOG���s E�h1AIL /J'L.t/bC��✓r�r��d.tiht/��t �.�. <br /> PI RA� '1 !' ADDRE IZ P H N <br /> �L��'�`��!dC.-� ��/1/'il�t:'�e_'�-��.-. �-� 7 �. I:i,rt�L� JC:'.. lr�(C ,�U�io . 1L.� ' (��IY <br /> l <br /> CONTR.LICENSE# — <br /> = l/r %�'—IZL 9S�112.�- <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> _Electric X Gas_Olher � ���L�' <br /> WORK DESCRIPTION � � <br /> r <br /> I<<,�,�,, < < y� �. .;,�:. < < <br /> PLUAkBING MECHANICAL <br /> N�O. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> '(oilet A/C–air handling unils <br /> Bathtub Forced air systems <br /> _ Lavalory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&tlisposal Gas fireplace <br /> Dishwasher �Gasrange <br /> Clothes washer Clothes dryer <br /> Water heater Range hood <br /> Sink(service/bar,mop�etc.) Exhaust fan <br /> BackOow�preven�er Heat pump <br /> Urnal Unit heater <br /> _ Drinking Fountain Boiler <br /> _ Floordrain Refrigeralion <br /> __ Grease Irep Woodstove� <br /> _ Roofdrains �_ O�her �'t,�'n,.c c, <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX COUE IS 1105 <br /> I hereby certify Ihal I have read and examined Ihis application and know the same to be true and correct. All provisions of laws and <br /> ordinances governing this type of work will be complied with whether specified herein or not.The grenting of a permil does not presume <br /> to give authority lo violale or cancel the provision of any other state or local law regulating conslmction or the peAormance of <br /> construction,,Thal I am authorized by lhe owner of this property to perform the work for which application is made and I comply with the <br /> State Conir ctors Law 18.27 RCW apd 296200 WAC. <br /> �.� Q,�/ti�-_ 7 �/S- /U <br /> Signalure of OwnedContractodAWhonzed Agent Date <br />