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� <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERV�CES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810- FAX 425-257-885i-www.everettwa.org <br /> APPLICO-'ONS ARE ACCEPTEil FROM 8 AM TO 4 PM �`� (pL�� 'd � ' <br /> SITE ADDRESS PARCEL TAX I.U.# PERMIT# <br /> ' �0i1� '�QT,: �1J`�: • �• �r� . 2$pr- I'-�U- �a'�-03G'"� � �G� ' .SoZ <br /> LEGAL LOTNO. 6LOCK TRACT O bU <br /> DESG �.:�-:C��i�Y-l'f-.:.(�%' <br /> OWNER ADDRESS CITYIZIP PHONE <br /> , �, . �-' �-,4,,,,,rp,� ,l.�l'Al"� z'�o� co=P�-I :u�-tE 12�^ 425'^u�z:54v;.� <br /> — •,-�;P�` . >,':��-1"�'_: �; _ `�'.t.! <br /> ..i - �uhn��r �..��ca• ��,�� <br /> TENANT NAME CON1"ACT FOR PERMIT Pi10NE <br /> ... __ c,��:r:,�; ��:�tif��:t.; �?���4Z-1�13;�� RF'iHa2 `t'e� b1 <br /> CONTRACTOR ADDRESS CITY2IP PHONE <br /> �,r:t':r,��_;,� <br /> CONTR.LICENSE# <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> 4�1 `�/.l i_ `../ .! i - . _Eleclric _Gas_Other -�� �j;; .)�-' i <br /> WORK DESCRIPTION <br /> � /� , ^ . �y %l.I �I� ._ ^ FI'��.�. . �. 1 : <br /> ^l�� .t .. ..j j ,�,'.I1 .��1.- �J,�1� T�JI':l iJ� ti�IIj���.T .�iY{ � I%V ...t% ��J � j..SJ�•L� I�� � �v <br /> t'� �_' . , ,1. 1-_... , 'n-�:�.,^�.,nyl'-1_ ��-�-• A Por�iln�.) '�5.: -tk�-c -�'/',�i11.,�� <br /> ;' ?.l�i.',i_. '..�.^�,' . I�.�V'.�.,1:�1��5 <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilel A/C—air handling units <br /> Bathlub Forced air systams <br /> Lavato,y(wash basin) Gas piping <br /> Shower Water healer <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Cbthes was`�er Cblhes dryer <br /> Water heater Range hood <br /> Sink(service/bar/mop/etc.) Exhausl fan <br /> Back(low preventer Heat pump <br /> W inal Unit heater <br /> Drinking faun�ain Boiler <br /> Floor drain Refrigeralion <br /> Grease lrap Woodstove <br /> Roof drains Other <br /> Olher <br /> CI7Y OF EVERETT LOCAL SALES TA7(CODE IS 3105 <br /> I hereby ceritify Ihal I have read and examined lhis application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing this lype of work will be complied with whelher specified herein or nol.The granting of a permit does not presume <br /> to give aulhority to violate or cancel the provis�on ot any other state or local law regulating construction or the performance of <br /> construction.That I am authorized by the owner of this property to perform lhe work for which application is made and I comply wilh the <br /> State Contractors-L'ew tII.27 RCW.and 29G.200 WAC. <br /> i <br /> � ,j ;: ._.. . •� ',. , � <br /> Signature of OwnedContraclor/Authorized Agent Date I/ <br />