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{ <br /> PERMIT APPLICATION <br /> CITY OF EVERETT PERMIT SERViCES -, <br /> 3200 CEDAR STREET, EVERETT, WA 98201 3 ��`� ��� <br /> 425-257-8810– FAX 425-257-8857–www.everettwa.org � <br /> ' � ,_ <br /> APPLICATIONS ARE ACCEPTED FROM S AM TO 4 PM �� �� -n '`� <br /> SITE ADDRESS (� AU� s� PARCEL TA%I.D.# PERMIT# / <br /> � 'z `:3�;�� - ,..,,, - .. ., . Z`Sn��3oo >�- �� ,or� -,,�c -� <br /> LL9AL LOT NO. ' BLOCK TRAGT OR SUBDIVi510N k <br /> DE-SC. �J Z -'U `j - �U � �('. <br /> OWNEF2 ADDRESS �ITYILP PHONE <br /> ►-��'�-� =��'r"� �.=�C�i'liL PO F':�,�k ��� i�CllirY r,ccn� �151_.r'��� <br /> TENANTNAME CONTACTFORPERMIT ` PHONE �{�� 4�'=i "f���L`L` <br /> ���f�l��'�1�Il ��.Y�l ��li�-C-1�w� �—�Y I v 41� � ��(e.L'-Y� E-MIUL��� FC/%' C� .Lr; u,6 � c �-i�,. <br /> �bATR7�CTb7�' • , . _ <br /> (� �Gt,i' I �-�ry .`-��iC}�l`7 � 1"1L- ,,,-/" _ r/ �tM <br /> , �-7ZlJ`{- f��G ��.• "t � nl'YlU;�. ti �-`� � 4 p7 `I(�Cd <br /> CONTR.LICENSE# \ 1�4�'OL� <br /> ��Lf-'1'(� Z�i `1 zl �i1. <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> C����1V '��' ti���CL� � �JC.��(1� —Electric _Gas_Other � �� ��( i�'��`-� �� <br /> WORK DESCRIPTION <br /> �' t�-icJL, e-}=i`�j������ `:.,��� ��...1C_ i � �������1( i'lt�l,t� <br /> PLUMBlNG MECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FI%TURE OR ITEM <br /> _ Toilet A/C-air handling unils <br /> _ Bathtub Forced air systems <br /> _ Lavatory(wash basin) Gas piping <br /> Shower Water healer <br /> _ Kitchen sink 8 disposal Gas freplace <br /> _ Dishwasher Gzsrange <br /> _ Clothes washer Clotyes dryer <br /> _ Water heater Range hood <br /> _ Sink(servicelbadmop/etc.) Exhaust tan <br /> _ Backflow preventer Heat pump <br /> _ Urinal Unit heater <br /> Orinking Fountain Boiler <br /> _ Floor drain Refrigeration <br />, _ Grease trap Woodstove <br /> Roof drains Uther <br /> Other — <br /> CIN OF EVERETT LOCAL SALES 7AX CODE IS 7�OS <br /> I hereby certify lhal�have read and examined this application and know the same to be true and correct. All provisions of lavrs and <br /> ordinances goveming this rype of work will be complied with whether specifed herein or not. The granting of a permit does not presume <br /> to give authority.to violate or cancel ihe provision of any other state or local law regulating construction or the per(ormance of <br /> construction��That I am authorized by ihe owner of this property tu perform the work for which application is made and I comply with the <br /> State Conicactors Law 7827 RCW_and 296200 WAC. ;: <br /> 4 _ _ / , <br /> � ..__..._._.__ . -, ' <br /> i-/%� �Z v'�/0 <br />��� Sgna re of OwnedContractor/Authonzed Ayent ' ! Date <br /> 1 <br /> �Z <br />