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PERIViIT APPLICATION <br /> ' CITY OF EVEF3ET'T PERMIT SERVICES <br /> 3200 �EDAR STREET, EVERETT,WA 98'L01 <br /> 425-257-8810— FAX 425-257-8857—www•everetlwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM 7 ..ad � II <br /> PARCEL TAX I.D.# PERMI'f# <br /> SITEJADDRESS ../� _U� <br /> �I�� C��U� /� ^(' . SE C�'C' ,`F ��� ^, '� , � 1 � � ' <br /> LEGAL LOT NO. DLOCK TRACT OR SUBOIVISION# <br /> DESC. <br /> ADDRESS CITYIZIP PHONE <br /> OWNER E��TET� <br /> �fm«5 5c�u.,,� 9315 l�,f� /-�e sE 9 � �o�� �rzs � �o- ys�� <br /> CONTACTFORPEFiMIT PHONE <br /> TENANTNAME � ✓J�QCG(l� L(�2�-��S'��I���� <br /> I �l�� �� E-t�1AIL <br /> AODFESS CITY(ZIP PHONE <br /> CONTRACTOFi � <br /> ��rY� n/ire �un+b. d- H T - lG� l�l l��'�� �, �l/_ L 4�niNu' � z5 ��s ��fl��l <br /> CONTR.LICENSER D�N-Z�!"H�G��� n� ��/S � � <br /> USE OF BUILDING j( �7 <br /> I HEAT SOURCE I CONTRACT PRICE OF WORK <br /> �Eleclric _Gas_Olher '/(' / L����• C� <br /> WORK DFSCRIPTION _ <br /> �'F�cf��E Cx �sn�,� ����c�aL- !%cr,�nirtcE l�,Tt-r N��� <br /> � �C-t.�'.'i-�'LIC �i�NACE � 3,� SA'n'i{�' LC'Cf}'"rl�/� • <br /> PLUMBING MECHANICAL <br /> NO. TYPE Of-FIXTURE OR ITEM <br /> N0. TYPE OF FIXTURE OR ITEM <br /> NC-air handlinc� units <br /> _ Toilel �_ Forced air systems <br /> __ BathWb Gas piping <br /> Lavalory(wash basin) Waler healer <br /> _ Shower Gas fireplace <br /> _ _ Kitchen sink&disposal — Gas range <br /> Dishwasher Clolhes dryer <br /> _ Clothes washer Range hood <br /> Water heater Exhaust tan <br /> _ Sink(sewice/har/mop�etc.) Heat pump <br />� Backflo�v preventer Unit heater <br /> Urinal Boiler <br /> _ Drinkinc�Fountain � Re(rigeration <br /> Floor drain W oodstove <br /> Grease trap �— Other — <br /> Root drains -- -- <br /> Other____ _ --- <br /> � I CITY OF EVERETT LOCAL SALES TAX CO�E IS 3105 <br /> I hereby cerilify lhal I have read and examined thi,application and know the same�0 6e irue and correct. All provisions of laws and <br /> ordinaces goveming ihis type ot work will be complied��ilh�vhetiier specilied herein or noL The granlin�ot a permit does not presume <br /> to�ive aulhorily to violale or cancel ihe provision of any olher stale or local latv rec�ulaling consimclion or the pedormance of <br /> � conslruction.Thal I am aulhorired by lhe o�vner ol this preperty to perlorm lhe work(or�vhich application is made and I compty�vilh the <br /> Slale Contr� ors Laev tII.27 d2�6200 WAC. <br /> � / <br /> '� / `- ,f' � -tL' � <br /> Si�nature o O nedContraclor/ horized Agenl Dale <br />