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PERMI� APPLICATION <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810 - FAX 425-257-8057-www.everetiwa.org D (��-Dg—� 7 <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT&CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS a�-t,� PARCEL TAX I.D.# PERMIT# <br /> 1( � l l'Z �'�/E' $� 0���?�170�i oi;� r.� .SO�o�- Co5 <br /> LEGA!. LOT NO. BLOCK TRACT <br /> DESC <br /> OWNER �`�� r� / � ADDRE�S .- qTY21P PHONE <br /> —\ <br /> �v� ��` I.l.�e �r AJ t�i^a,�0 / �" '�'''� �" �% �/.?S- 8�2s T2 <br /> TENANTNAME CONTACTFORPERMIT PHONE L�x- <br /> �14Q-� S'�"(2n i v tv� I���a✓1... 2 822 /Z.� v <br /> C'�'�}'�05�� T �-'.�Iv S�,S5�7� �/ �✓lL4l� PHONEy��21LVV <br /> i �• � C� <br /> CONTR.LICENSE#Al�,w � �� p� D /� <br /> 7 /�1 V <br /> USE OF BUILDING HEAT SOURCE I CONTRACT PRI:E OF WORK <br /> � _{.,, a�O <br /> ,.� l V ( � _Electric _Gas_Olher � b��j ` <br /> WORKQESCRIPTION �y—•�S��C� � L�,L� �0�1t/�•i / �-LLk� <br /> �.L «+L/ <br /> � '��/ �� � <br /> PLUMBING MECHANICAL ' <br /> NO. TYpE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C-air handliny units <br /> _ Bathtub Forc�d air systems <br /> Lavalory(wash basin) Gas piping <br /> Shower Water heater <br /> Kitchen sink&disposal Gas fireplace <br /> Dishwasher Gas range <br /> Clothes washer Clothes dryer <br /> _ Laundrytrey _ Ran§e'Food�",: :::� . ; c;�,mpii;:,,�. ,.,... <br /> _ Sink(servicelbadmopletcJ _ Exhaiisl'(afi� =��(�%��,:r���; ,iisrrN;;��.,,:�.�. <br /> � �ackflow preventer _ Heat"p��'tip�,'�L. � �� �' <br /> Urinal Unithe eY � .__ %�j� <br /> _ Drinking Founlain Boi�e� �— - " _i�;� �> <br /> Floordrain Refrigerati �����'nn/c nr,nt �� <br /> � _ Grease trap _ Woodsto e <br /> Roo(drains . Other <br /> Olher <br /> CITY OF EVERETT LOCAL SALES 7/il(CODE IS 3105 <br /> I hereby ceritify that I have read and examined this applicalion and know the same to be true and correct. All provisions o(laws and <br /> ordinaces goveming this rype of viork will be complied with whether specified herein or not.The granting of a permit does not presume <br /> to give authority to violate or cancel the provision of any other state or local law regulating construction or the pedormance of <br /> const �dion.That I am authorized by the owner of this property to perform the work tor which application is made and I comply wilh the <br /> Stat ontractors Law 16.27 RCW,y3nd 296.200 WAC. <br /> �.N���- � �1 � `'1 <br /> Sign ure of Owner/Con actor/Authonzed Agent Dale <br />