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. -, � <br /> PtRMIT 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 �� _�S-� <br /> SITEAODRESS �,4 \G iG�� r��� St PARCELTAXI.D. # P MIT# <br /> �� ��- . W ' q ,2 '� 0�'S7�( 7 vo�o/(,.-v �i I� 70� - D <br /> LEGAL LOT N0. BLOCK TRACT OR SUB�IVISION# <br /> DESC. <br /> OWNER ADDRESS CITY2IP PHONE <br /> ���p�01 t� 1 N C <br /> TENAN`T,NAME ��` � CONTACTFORPERMIT PHONE 2pb -qq1323 � <br /> VY"`N �'N� C � � 1'"Q� ��.FF��� UF- \�UH E•MAIL :1DUIZTC(�.I��SDb�OG� �� <br /> CONTRACT R ADD S � CI I�P O <br /> P��o���55�vc Sys�FN�.s; �,�- c 2S35-F t���Po�w��t s 2o �-?�b-��4,�, <br /> CONTR.LICENSE# �n 1 `L� }w ^ n �,1�� , <br /> H �-1 �l <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> Q�ST1a���1�' � _Electric ��Gas_Olher �J �ei LL <br /> WORK DESCRIPTION <br /> �N�zut;�, �� �o� �� ��Q � � 1-1�0� <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. IYPE OF FIXTURE OR ITEM <br /> Toilet A/C–air handling units <br /> Bathtub Forced air systems <br /> I_avalory(wash basin) _ Gas piping <br /> Shower Waler heater <br /> Kilchen sink&disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Clolhes washer Clolhes dryer <br /> Waler heater ✓ Range hood <br /> Sink(servicelbarlmoplelc.) ✓ Exhaust ian <br /> Backflow preventer _ Heat pump <br /> Urin21 _ Unit heater <br /> Drinking Founlain _ Boiler <br /> Fioordrain _ Refrigeration <br /> _ Grease trap _ Woodstove <br /> Roof drains _ Other ��(Q� ±�N U On <br /> Other — — <br /> CIN OF EVERETT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriGfy that I have read and examined this application and know the same to be true and correct. Ail provisions of laws and <br /> ordinaces goveming this type of work will be complied with whelher specified herein or not.The grantiny of a permil does not presume <br /> lo give authority lo viclale or cancel the provision of any olher state or local law regulating conslruction or the per(ormance of <br /> conslruction.Thal I am authorized by Ihe ov+ner of this properly to perfortn the work tor which application is made and I comply with the <br /> Slale ConU clor L�w 18.27 RCW and 2�36.200 WAC. <br /> �-�Pi 2� zoo�7 <br /> SignaWre O n dContr clorlAulhonzedAc�ent Date I <br /> �L <br />