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PE. IMIT APPLICATI4. � <br /> CITY OF EVERETT PERMIT SERViCES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 ///��� <br /> 425-257-881 U— FAX. 425-257-8857—w�,vw.everettwa.org ���� ^/ li I <br /> /.✓ <br /> APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DEBIT& CREDIT CARDS ARE NOT ACCEPTED <br /> SITE ADDRESS PARCEL TAX I.D.# l�E�iMIT# <br /> `��z 2 ,� `f f>�, -���-i C» Cl`f <br /> LEGAL LOT�0. OLOCK TRACT�,, ,�r� <br /> DESC. �- <br /> � l_�J-I�.it/ 1 <br /> OWNER ADDRESS J CITYlZIP PHONE � <br /> Y'S 2 3[ <br /> /Q 4/> /'.�,.�Gz�Q,E� .�L c /`�/��r riu C�,,.�;,, �/z s..z 3 s s z z ,� <br /> TENANT NAME � CONTACT FOR PERM[T PHONE <br /> I ��lY�� ���cc-,o _ 3 G o- 'y'� -/ 9 s�' <br /> C NTRACI'OR G �« ADDRESS CI7Y21P PHONI: <br /> �Fa i=� � y� a�c <br /> CONTR.LICENSE# <br /> Pr�.�t�f-c� �t o i i < Q f'/D�x 9io G�..� �E �-3 SY-�6� � <br /> USE OF BUILDING , I — HEAT SOURCE I CONTRACT�RICE OF WORK <br /> ��7 �'��u�� Electric �Gas Other 9 � � p o <br /> 0 <br /> WORK DESCRIPTION <br /> /Y.R.�� N�.� - S,'.� �. <br /> I�� /'��. A - z <br /> PLUMBiNG MECHANICAL <br /> N0. I TYPE OF FIXTURE OR ITEM N0. TYPE OF FIXTURE OR!TEM <br /> 3 Toilet A/C-air handling units <br /> � Bathtub / Forced air systems <br /> Lavatory(+vash basin) � Gas piping <br /> QL Shower � Water heater <br /> � Ki�chen sink&disposal � Gas fireplace <br /> Gishwasher � Gas range <br /> � Cl�thes washer Cbthes dryer <br /> _ Laundry tray Range hood <br /> Sink(service/badmop/etc.) Exhaust fan <br /> � Eackflow preventer Heat pump <br /> lhinal Unit heater <br /> C)nnking Fountain Boiler <br /> f loor drain Refrioeration <br /> � Grease Irep Woodstove <br /> I _ Rcrof drains _ Other <br /> Olher <br /> � — — <br /> ICITY OF EVERETf LOCAI SALES SAX CODE IS 3105 <br /> 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��vill be complied�.vith�vhether specified herein or not.The granting of a permit does not presume <br /> to give authonty to violate or cancel the provision of any other state er local law regulating construction or the performance of <br /> construction. Thai I am authorized by the owner of this property to pertorm the work for which application is made and I ramply with the � <br /> State Contractors Law 18.27 RCW and 296.200 VVAC. � <br /> ��:"�/r�,/ti�'�C //i z/�s- i <br /> I Signature ot Owner/ on ractoqAuthonzed Agent D� � <br /> � /a II <br />