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PERMIT i4PPLICATION <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 /> Ahi LICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERNFIT# <br /> Ii0 y ���' �-�U� �c � ,� �1�� ��� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> DESC. <br /> OWNER ADDRESS CITYIZIP PHONE <br /> S �o-f dr,� V'��ca,Cv�.� <br /> TENANTNAME CONTACTFORPERMIT PHONE 7 �SD SG <br /> S(,�,�, �vO a{- �C!I J er�rr1.C, (,vr�K �� E-MAIL <br /> O TRACTOR �,�p � ,P(«.M �hGs Tr1C � ADDR SS 1�3?/ •n/E,�,f. �' CITYI2IP PHONE �� c)� <br /> 5_ g' 7 rnb✓�fdC f <br /> CONTR.LICENSEiIwnI���11-D3�SGJ ��� f <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> r n,� v✓i ! r-C�Q� _Electric _Gas_Other � �j a(J Q <br /> / � �'( � <br /> WORK DESCRIPTION • • <br /> P r,r� �� �_ � Y1r. ��V t-r'rGt in ��c�c-� L iri.E' t0 ,L�OZ`�`Z tt�'lp/7t <br /> �—��.a � c. r . <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C–air handling units <br /> Bathtub Forced air systems <br /> Lavalory(wash basin) _ Gas piping <br /> Shower W aler healer <br /> Kitchen sink 8 dispusal Gas(ireplace <br /> Dishwasher Gas ranpe <br /> Clothes washer Clolhes dryer <br /> VJaler healer Range hood <br /> Sink(service/badmop/elc.) Exhaust fan <br /> Back(low prevenler Heat pump <br /> Urinal Unit heater <br /> Drinking Four�lain Boiler <br /> Floor drain Refrigeration <br />� Grease Uap _ Woodstove <br /> Roof drains Other <br /> Other <br /> CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y that I have read and examined lhis application and know the same to be true and correcL All provisions of laws and <br /> ordinaces yoverninc�lhis lype of work will be complied wilh whelher specified herein or noL The granting of a permit does not presume <br /> to give authority to violate or can el he provision ot any other stale or local law regul2ting construction or lhe peAormance of <br /> construction.That I am aulhorizgd b lhe owner o(lh!s property lo per(orm the wcrk for whir.h applicalion is mc�fe and I comply with lhe <br /> Slale Contraclors Lmv 1827 RGyY�jnd 296200 WAC. <br /> _ ``"' "' + ' � � f2 -OS <br /> - _ _ . � _ <br /> �Si�—a,naWre of Owner/Conlractod ulhorized Agent Dale <br />