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P�RMIT APPLICATIO�� ' <br /> CITY OF �VERETT PEi2MIT SERVICES , <br /> 3200 CEDAR STREET, EVERETT, WA 98201 � <br /> 425-257-fi810 — FAX 425-257-8857 —wvdw.everettwa.org �{ 7 <br /> I APPL.ICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - DtBIT & CREDIT CARDS ARE NO�A C PTE / ' <br /> I SITE A�DRESS � PARCEL TA%I.D. # PERMIT# � <br /> .�"� s � .l�',�� lz �s3o�� ao� �C' 7-�'/7�, <br /> � L'eGAL LOT NO. BLOCK TRACT � % � � C I <br /> oesc.� i -� /-�.t,�`rC7-CZ� i <br /> i / � � <br /> I OWNER ADDRESS CITY/ZIP PHONE j Co _� y/_,��i ./ <br /> �s� C� P��/�� C/�EE� �L C ��,�071 f`,!G C L J�{�fN GJ.v _ ���s� <br /> � � <br /> TENANT NAME CONTACT FOR PERMIT PHONE I <br /> • ,�/�� � O/`�/_' � �3 ,�'«.':�''� ? � I <br /> �� CONTRACTOg �r.� � i N�i �F�/ ADDRF.SS CITY/ZIP P ONE ; <br /> �ii�/(� C�"= . , .. 3,•�"-3•fi- 5`60 � , <br /> �. CONT LICEMSE# �Q � ' <br /> �i�_�' cL G �.2 L B � ,�o ,�yi� C �i�v�`o� �d.f ��8 z�l _ , <br /> USE OF BUILDING HEAT SOURCE CONTRACT PRICE OF WORK I <br /> � ��� �y � Eleclric �Gas i Uther /� � � Q G I <br /> ���✓u.� �- F - <br /> �: WORK CESCRIPTION I <br /> ! /UN O � /�/�• � r�N�L � fh�vii /\� /) �dc//i �✓c� �, <br /> C pNS f�' tt� / <br /> �—� — ��i�_�i c_.1��� <br /> PLUMBING MECHANICAL � <br /> � NO. I TYPE OF FIXTURE OR ITEM NO. 1YPE OF FIXTURE OR ITEM ' <br /> �� 3 Toilet A/C—air handlinc� units '� <br /> � I Ba!htub Forced air systems � <br /> '� Lavatory (wash basin) � Gas piping ! <br /> Shower � VVater heater ' <br /> _f Kitchr� sink 3 disposal Gas fireplace �� <br /> ; � Dishwasher Gas rahge <br /> � Clothes washer � C.lothes dryer i <br /> _LILaundry trey � Range hood <br /> Sink(servicelbadmopletc.) �/ Exhaust fan I! <br />�I _ BackAow preventer � ^_ Heat pump I <br /> Urinal Unil healer <br /> Orinking Foantain Boiler <br /> Floor drai❑ Refrigeration i <br /> Giease trap Woodstove <br /> Roor drains Other <br /> Gther ' <br /> CITY Of EVERE77 LOCAL SALES TAX CODE IS 3/05 <br /> i nzreny centify Ihat ' have read and exainined this applicalion and know the same to ba frue and correct. All provisions o!la�vs .�nd <br /> �roinaces governing this type of work�.vill ba complied with whether speci(ied herein or not.The granting o(a petmit does not presume '� <br /> . ;o grve au�horiry to violate or cancel the provision of any other state or local law regulating construction or ihe performance of , <br /> construction. That I am autherized by the owner o(this propeRy to per(orm the�vork for which appiication is made and I comply�.vith tne ' <br /> Stat> Contractors Law 1827 RCW-and 296.200 WAC. <br /> � �--— <br /> � ��� i i � � � <br /> � � [,r.;. .:, ,%- , ; ,-,, _' � � <br /> � Si9nawre of OwnerlContractorlAuthorizetl Agent Date �/� <br /> (Z <br />