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� <br /> �I P�tMIT �4PPLICATIO�a � <br /> � CITY OF EVERETT PERMIT SERVICES � <br /> 3200 CEDAR STREET, EVERETT, WA 982'J1 \ � <br /> 425-257-8810— FAX 425-257-8857—www.everettwa.org %�3�.G�� \ <br /> � � <br /> APPLICATIONS ARE ACCEPTED FROM li AM TO 4 PM - DEBIT & �RE�11T CARDS AF<E NOT ACCEPTED j <br /> SITE ADDRFSS � PARCEL TAX I.D.tl P M�T*D �I�/ I <br /> S�SD S" 1�� b <br /> LEGAL LOTNO_ BLOCK TRACT <br /> DESC. U <br /> OWNER ADDRESS CITY2IP PHONE ^� �o _� Sc�_y� �� I <br /> ;4¢ v ��/P,1(" C/�EE/r .LL C /jo,��f�o c�,�✓fN �A - y�2j� ; <br /> TENANTNAME CONTACTFORPERMIT PHONE � <br /> ;���� �o/��E � ��,f �.�2 - � :� ? � i <br /> CQNTRA TO ��� � i.v�i f'rc� A�:IRESS CITY2IP 3P��E p�/- 5�6�0 °f <br /> ��/t%�`' �/�- - <br /> CON R.LICENSE# �°j e /�o ?(yjv �,C iN7`o�� 4J,f y�'Y�� <br /> �9-,���-� o/z �9 <br /> f HEAT SOURCE CONTRACT PRICE OF N'ORK <br /> USE OF BUILDING <br /> S/��� E-- F�/v,. / _Electric � Gas_Other /� y � �Q <br /> WORK DESCRIPTION <br /> ��J S'iN�.0 F' /rh�v�� /" f� 4JE//��✓� <br /> G o N ,f J`�(k C�`-�o•.� a � N - � <br /> . � , _/ <br /> PLUMBING ECHANICAL <br /> NO. TYPE OF FIXTURE OR ITEHi NO. TYPE OF FIXTUI2E OR ITEM <br /> 3 Toilet A/C-air handling units <br /> 2 B;thtub � Forced air systems <br /> � Lavatory (wash basin) Gas piping <br /> Shower Waterheater <br /> � Kitchen sink 8 disposal � Gas fireplaca <br /> Dishwasher t Gas r�ange I <br /> , � Clothes washer � Clolhes dryer <br /> � Laundry tray Range hood <br /> _ Sink (service�bar/mop/etc.) � Exhaustfan <br /> Backflow preventer _ Heat pump <br /> ' Urinai _ Unit heater <br /> ' Drinking Fountain __ Boiler <br /> Floor drain _ Refrigeraliar . , <br /> I _ Grease trap _ Woodslove <br /> Roof drains Other <br /> I _ Other — <br /> i <br /> � CITY OF EVERETT LOCAL SALES 7AX CODE IS 3105 <br /> : I hereby ceritify that I have read and examined this application and know the same to be Vue 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 peTrttit does not presume <br /> co give authoriry to violate or cancel the provision ef any other slale or local law regulating construction or the performance of <br /> construction. That I am authorized by the owner of lhis property to per(orm the work for which application is made and I comply with Ihe <br /> I Stzte Conqactors Law 18.27 RCW and 296.200 WAC. <br /> i <br /> i ,��},f! .�j?j' . -�r,� (._/,%. � �-Z �` U '� <br /> i Signa�ure of OwnedContractor/Authorized Agent Date �L <br />