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PCRMIT APPLICATI�,N <br /> CITY OF EVERETT PERM17 SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 —www.everettwa.org <br /> APPLICATIONS ARE ACCEPl'ED FROM 8 AM TO 4 PM <br /> SITE ADDRESS PARCEL TAX I.D.# PERMIT# <br /> /�, �I� 7 �07� Q- �,� ���� <br /> LEGAL LOT NO. BLOCK TRACT OR SUBDIVISION# <br /> UESC. <br /> OWNER ADDRESS CITY/ZIP PHONE <br /> ,/� �z�-3�9—/6J` <br /> �� �/�n y ✓1 4/%�,�ri �r �0�� ? /G7/� /�, S.� �'�ir-�0�'��.`3 <br /> TENANT NAM�� CONTACT FOR PERMIT PHONE <br /> ��� Cl% / t%� �rzs-�.3y i �z_ G� <br /> E•MAIL <br /> CONTRACTOR ,. � ADDRESS CITYIZIP PHONE <br /> �y ,;��<��� s�,is � sf��y-� � 3��,��=��..���� y z s� �. >�- z�6 <br /> CONTR.LICENSE N � .. � � �C.�j�,� > > <br /> .Evl f,�/v 5-��� / 2 kZ 9�_ c / <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK <br /> r <br /> J��°5 �Electric _Gas_Other �7�L�C� � <br /> WORK DESCRIPTION <br /> ��, „�;/ ��� f�,�, �j��,�,��� s�� �<<<� � <br /> PLUMBING MECHANICAL <br /> NO. NPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handling unils <br /> Ba1hWb � Forced air systems <br /> Lavatory(wash basin) _ Gas piping <br /> Showcr Water heater <br /> Kilchen sink 8 disposal Gas tireplace <br /> Dishwasher Gas range <br /> I Clolhes washer Clothes dryer <br /> Waler healer Range hood <br />� Sink(service/badmop/etc.) Exhausl(an <br />� Back(low preventer � Heat pump <br /> Urinal Unil heater <br /> Drinking Fuuntain _ Boiler <br /> Floor drain Refrigeration <br /> Grease trap _ Woodstove <br /> Roo(drains Olher <br /> Other <br /> CITY OF EVEREIT LOCAL SALES TAX CODE IS 3105 <br /> I hereby ceriti(y lhal I have read and examined lhis applicalion and know lhe same lo be lrue and correcl. All provisions of laws and <br /> ordinaces goveminc� this type o(work will be complied wilh whelher specified herein or nol The c�ranting o�a permil does nol presume <br /> to give authority lo violate or cancel the provision ot any other slale or local law regulating wnslruclion or lhe performance of <br /> construclion. Thal I am aulhorized by the owner of this properly lo pedorm lhe work for which application is made and I comply wilh the <br /> Slale Con�ctor/La 18,27 CW an�,200 WAC. <br /> i � ,r <br /> ��/ ��/� � � �"J �G�� <br /> Signalure of OwnedConlraclorlAulhorized Agenl Dale <br />