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P�RMIT APPLICATIG�J <br /> CITY OF EVER�TT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-8857-www.everettwa.org �a `a�_,�R <br /> / <br /> — APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM �\/�Q J� -�ia <br /> � <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> 7S �`i - �S �,- - � <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> /yl ,-�-r�t ��� �Mf._ <br /> TENANT NaME CONTACT FOR PERMIT PHONE <br /> �AMS-_ .,L� 2ob-Z� / S7�- <br /> e-Ma� <br /> ONTRACTOR A RESS I ll P <br /> ���� 3,��:,��, l'r��_o��:� s-z��, � ti�, 11cr�- �06•3� � S�'� <br /> CONTR.LICENSE!! � <br /> ����, k_� �-`�5,� J.� 1����� <br /> +'�O� — <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �. <br /> �Z�-� ��f N�L _Electric �Gas_Other /�c�� <br /> L _ <br /> WORK DESCRIPTION � <br /> �. � �� .^-�:5� :,..i� C r+�l' �`ll/Ini� C_ �iL <br /> PLIiMBING MECHANICAL <br /> N0. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> Toilet A�C-air handling units <br /> Bathtub Forced air systems <br /> _ Lavatory(wash basin) �� Gas piping <br /> Shower � v� Water healer <br /> � Kitehen sink 8 disposal �� Gas fireplace <br /> �_ Dishwasher �_ Gas range <br /> �_ Clolhes washer �� Clothes dryer <br /> _ Water heater _J_ Range hood <br /> _ Si,ik(service/bar/mop/etc.) �_ Exhaust tan <br /> �ackllow preventer Heat pump <br /> Urinal Unit healer <br /> Drinking Fountain Boiler <br /> Floor drain Refrigeralion <br /> Greaso lrap Woodstove <br /> Roo(drains Olher <br /> Olher <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby cerili(y that I have read and examined this applicalion and know lhe same lo be true and correct. All provisions of laws and <br /> ordinaces governing this type of work will be compliod with whether spec�ed herein or not.The granling of a permit does nol presume <br /> to give aulhoriry lo violate or cancel the provision of any other state or local law regulating construction or ihe performaace oF <br /> consirudion.That I am aulhorized by the owner of this property to per(orm the work for which application is made and I comply wilh the <br /> Stale Conlnctors Law 18.27 RCW and 296.200 WAC. I <br /> � � <br /> l � (Z �� llS <br /> , —, <br /> �. <br /> Signalure of OwnedContraclor/Authorized Agenl Date <br />