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� PL�MIT APPLICATIO�� <br /> CITY OF EVERETT PERMIT SERWICE� i <br /> 3200 CEDAR STREET, EVERETT, WA 98201 I <br /> 425-257-8810- FAX 425-257-8857 -www.everettwa.org �C{31Z��� � <br /> [/ <br /> APPLICATIONS ARE ACCEPTED FROM F AM TO 4 PM - DEBIT 8 CREDIT CARDS ARE NOT ACCEPTED I <br /> SITE ADDRE�S � PARCEL TAX I.D.# I p MIT# �I �/ I <br /> 4�So � 1�� L p ; i <br /> �EGAL LOTNO_ BLOCK TRACT <br /> DESC. U <br /> OWNER ADDRESS CITY2IP PHONE 3 �a -3 y�/-y� �S � <br /> i�`�`' Q ��/P� C/�EEf� l.� C �,�d71 f`�/O C`/��/f/V �iJ/9 ' �` �2 3(' , <br /> TENANT NAME CONTACT FOR PERMIT PHONE <br /> I �✓i�� �o� l /� /�1 -/'Z,� �.Z 2 - G �,1c '7 7 I <br /> C NTRACTO /Ni I�'�c� �DRESS CITY2IP P�oE J�F/- `{6�0 � <br /> �ile;�(' �/�(�'-`,f L 3 � , <br /> CON R. LICENSE k l'/e �o .xy'jv [,C iN7`o�'r� �/� fg'P,�� <br /> k�,e,�c� 0,2 �� <br /> USE OF BUILDING NEAT SOURCE CONTRACT PRICE OF WORK <br /> S��F��- F/¢/Y�. / _Electric � Gas_Other /� y Q Q Q <br /> WORKDESCRIPTION ��V'/ / � �E./����� <br /> G o N ,f f./fk �t,o..� a �' N�� s-..,��,� � �' y <br /> � <br /> , � _ -/ , <br /> PLUMBING ECHANICAL { <br /> NO. TYPE OF FIXTURE OR ITEM NO. TYPE OF FIXTURE OR ITEM � <br /> 3 Toile: A/C-airhandlingunits � <br /> i 2 Bathtub � Forced air syslems <br /> � Lavatory (wash basin) Gas piping <br /> Shower Waterheater <br /> / Kitchen sink 8 disposal � Gas fireplace <br /> Gas r�ange <br /> � Dishwasher � Clolhes dryer <br /> i 1_ Clothes washer � Range hood <br /> L Laundry tray � <br /> Sink (se�vice/bar/mopletcJ Exhaust tan <br /> I _ Backflow preventer _ Heat pump <br /> Urinal _ Unit healer <br /> Drinking Fountain ,_ Boiler � <br /> r'loor drain _ Refrigeration . , <br /> I _ Grease trap _ �W„8 stove <br /> I _ Roof drains — <br /> � _ Other — <br /> _ I — <br /> I CITY OF EVERETT LOCAL SALES SAX CODE IS 3105 � <br /> I hereby ceritiry tha;I have read and examined this application ar.d know the same to be true and correct. All provisions of laws and I <br /> ordinaces governing this type of work will be complied wilh whether specified herein or not.The granting of a peTmit does nol presume <br /> to give authoriry to violate or cancel the provision of any other state or local law regulatlng construction or lhe performance of <br /> construction. That I am authorized by the owner of this property to perform the work for which applicado�� is made and I comply with the <br /> ' State Con�ractcrs Law 18.27 RCW and 296.200 WAC. <br /> . j S� <br /> �� ���1� '-�/� /� ' '� (,�,- ,, � 7� 7- u � <br /> Signature of OwnedContraclor/Authorized Agent Date �L I <br /> i <br />