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P�RMIT APPLI�ATIC��`J <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 TU 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCE�-iED <br /> SITE I\DDRESS PARCEL TAX LD.# P�RNI'P# � <br /> i <br /> I i t cJ �- `� DZ �� <br /> LEGAL LOTNO. BLOCK TRACT <br /> DESC. <br /> OWNER A�DRESS CITYRIP PHONE <br /> 1��I IJc2 �du,�e�i UUd7ntc✓1T' PO �3oX IOS9 SNfY•/Gn l�sl�(9R�G � tia..�' �� 5ot8 <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> / I Z2� �?c�Cc5 s <br /> CONTRACTOR A�DRESS CITY2IP PHONE <br /> �VuR���n�esr -Pl,�m�in, C_ov�`� <br /> CONTR.LICENSE# <br /> Dl2 PGO �S—/�R �KIO 1 �61'11 P� A1C"Z�.?,3 Rr1+.a�re�.9SZZ-3 ��EO 6537� 4 <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> r���� _Electric _Gas_Other <br /> WORK DESCRIPTION <br /> ��u rn��a�� Tc�r- 7-0, lcz I c9�/ � � _ <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 /> � Lavatory(wash basin) _ Gas piping <br /> Shower W ater heater <br /> Kitchen sink&disposal _ Gas fireplace <br /> Dishwasher Gas range <br /> Cbthes washer Clothes dryer <br /> Laundry tray _ Range hood <br /> Sink(service/bar/mop/etc.) _ Exhausl fan <br /> Backflow preventer _ Heatpump <br /> Urinal Unit heater <br /> Drinking Fountain _ Boiler <br /> Floor drain Refrigeration <br /> Gre�se trap _ Woodstove <br /> i _ Roof drains = Other <br /> Olher <br /> � T Nw•r — <br /> i <br /> � <br /> � CITY OF EVEREIT LOCAL SALES SAX COOE IS 3'105 <br /> � I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of Iaws and <br /> ordinaces goveming this type of work 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 regulaling consWc6on or the performance of <br /> construction.That I am authorized by the ewner of this property to perform the work for which application is made and I comply with the <br /> State Conlrac;ors Law 18.27 RCW and 296200 WAC. <br /> / � <br /> I C' L`1 ( CJ �I�FI S �S^ S"O�-� I � <br /> Signature of Owner/Conlracror/Auihonzed Agent Dale <br />