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P�RMIT APPLICATIC.�� <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-881C — FAX 425-257-8857—www.everettwa.org <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITEA�DRESS � ^ ' 1 � �� PARCELTAXI.D.# M(�SO -I" G�I� <br /> �, � <br /> Gr�-� <br /> LEGAL LOTNO. BLOCK TRACT '�. <br /> DESC. <br /> OWNER ADORESS CITY2IP PHONE <br /> v�� G ,� �'7107 .�- Q,;� , 1.� '�d��5`1- 13�� <br /> ENANT NAME � CONTACT FOR PERMIT PHONE <br /> �'f1�f�� aS�• y� � 6 <br /> CONTRACTOR .�,,- ��/ A0,RESS CITY2IP PHONE <br /> CONTR.LICENSE# v� J // ��_��S � �� <br /> Cinl-F�i� 7 k nU`�I� t3 �/� u�� 9 ao 1 <br /> USE OF BUILDING HEAT SOURCE GONTRACT PRICE OF WORK <br /> _Electric �Gas_Other <br /> WORK DESCRIPTION <br /> �� �r2c _ ����� Fzc_e.- - ��70 T�� � <br /> , <br /> PLUMB G MECHANICAL <br /> NO. TYPE OP FI;CTURE QR I7EM NO. NPE OF FIXTURE OR ITEM <br /> Toilet A/C—air handliny units <br /> Bathtub Forced air systems <br /> Lavatory(wash basin) Gas piping <br /> Shower � Water heater <br /> _ Kitchen sink& disposal � Gas fireplace <br /> Dishwasher Gas renge <br /> Clothes washer Clothes dryer <br /> Laundry tray _ Range hood <br /> i Sink (sevice/badmop/etc.) Exhausl fan <br /> Back(low preventer Heat pump <br /> Unnal Unit heater <br /> Drinking Fountain Boiler <br /> Floor drein Refrigeration <br /> Grease trap Wocdstove <br /> Roc�drains Other <br /> Other <br /> —I — <br /> I CITY OP EVERETT LOCAL SALES SAX COOE IS 7105 <br /> i I hereby ceritify that I have read and examined this application and know the same to be true and correct. All provisions of laws and <br /> ordinaces governing 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 regulatlng construction or the performance of <br /> construction.That I am authorized by the owner of this property ro perform the work for which application is made and I compty with the <br /> State C/ontractors Law 18.27 RCW and 296.200 WAC. <br /> C,�C��nr�,� ���� Gz� <br /> Signature of OwnedContracton u onze Agent Oate <br />